Two in one: patient-controlled epidural analgesia (PCEA) to prevent erection and control pain in adult hypospadias-surgery patients

Şengezer, Mustafa; Deveci̇, Mustafa; Öztürk, Serdar; Kurt, Ercan; Süer, A. H.; Bozkurt, Mehmet

doi:10.1054/bjps.2002.3906

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…Most of these data are on the psychosocial consequences [6][7][8][9][10] of the surgery, but only a few studies report data on the overall success and complications of hypospadias repair in adults [11][12][13][14] . In spite of the fact that surgical techniques are similar, the results of hypospadias surgery in pediatric and adult cases are different.…”

Section: Introductionmentioning

confidence: 99%

Distal Hypospadias Repair in Adults: The Results of 97 Cases

Adayener¹,

Akyol

2006

Urol Int

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Introduction: We reviewed our 9-year experience on 97 men with distal hypospadias who had undergone hypospadias surgeries. Subjects and Methods: Patients were divided into two groups: group 1 included 17 men who had one or more unsuccessful surgeries in their childhood, and group 2 included 80 men with no previous hypospadias repairs. Meatal positions were glanular in 6, coronal in 35 and subcoronal in 56 patients. Our 97 hypospadias surgeries involved 42 meatal advancement and glanuloplasty, 41 Mathieu and 14 tubularized incised plate urethroplasty procedures. Results: The overall success rate was 88% (86 of the 97 patients). The success rate was 76.5% for group 1 (13 of the 17 patients) and 91.3% for group 2 (73 of the 80 patients). Better voiding function and good cosmetic appearance was achieved in all patients. Urinary flow rates were significantly higher in all groups postoperatively. The success rates were 91.4 and 85% for the patients with preoperative coronal and subcoronal meatal positions, respectively. The success rate was significantly lower in crippled cases and in cases with longer neourethra. Conclusion: Although the same techniques are used for children and adults in hypospadias surgery, the results in adults differ from those in children. The success rate for primary adult cases is quite acceptable, but it is decreased in patients having longer neourethra and having multiple previous interventions.

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Section: Introductionmentioning

confidence: 99%

Distal Hypospadias Repair in Adults: The Results of 97 Cases

Adayener¹,

Akyol

2006

Urol Int

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“…Hypospadias is one of the most common congenital anomalies in boys that require corrective surgery (16). In addition to hypospadias correction surgery, other urinary tract repair surgeries such as urethral tightness repair using oral mucosa are also common surgeries in reconstructive urology.…”

Section: Discussionmentioning

confidence: 99%

“…In another study conducted by Ayenayli et al, the use of epidural catheters with a caudal block had a good effect on erection prevention (7). In another study performed by Sengezer et al investigating epidural catheter insertion and continuous infusion of fentanyl and bupivacaine compared to the group without a catheter, erection did not occur in the group with an epidural catheter, and using this method was recommended to prevent this problem (16). In our study, during the entire seven days of the study, in the first group, 13 erections occurred, including complete and partial erections, amounting to 0.87 per person (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Epidural Dexmedetomidine Versus Ropivacaine Infusion Effectiveness in Preventing Erection Following Reconstructive Urethral Surgery: A Randomized Clinical Trial

2021

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Background: One of the most common devastating problems that occur after urethroplasty is erection, which causes surgical complications (fistula, wound dehiscence, and surgical graft failure) and the need for repairing the complications. We attempted to compare the effect of continuous epidural infusion of dexmedetomidine and ropivacaine as a post-surgical erection prevention strategy. Objectives: In this study, we aimed to compare the effect of dexmedetomidine and ropivacaine epidural infusion on the incidence of erection after reconstructive urethral surgery. Methods: An RCT was conducted on 45 patients who were scheduled for reconstructive urethral surgery. They were randomly divided into three groups: (1) control (n = 15), (2) epidural dexmedetomidine (n = 15), (3) and epidural ropivacaine (n = 15). The control group received oral medication after surgery according to the conventional method (cyproterone compound tablets 50 mg BD and diazepam tablets 2 mg TDS for a week) to prevent erection. The DEX group received dexmedetomidine as continuous epidural infusion, and the ROP group received ropivacaine in addition to the conventional method. The occurrence of erection during day and night was recorded separately until the seventh day after surgery. Due to the long-time interval between case selection, participants from different groups were not matched with each other. Results: The incidence of erection in the dexmedetomidine group was lower than that in the ropivacaine group per person (0.87) and significantly lower than in the control group (2.8 per person). Also, there was significantly less erection in the ropivacaine group (1.2 per person) than in the control group. Our study showed that erection after surgery significantly decreased with the continuous epidural infusion of dexmedetomidine and ropivacaine. Conclusions: Dexmedetomidine seems to have a significant preventive effect on erection after reconstructive urethral surgery.

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“…This method ensures an uninterrupted, painless, and stable anesthesia. Some studies also report application of caudal anesthesia for management of postoperative discomfort [5,6]. Experience with hypospadias repair in adults is generally limited in developed countries [7].…”

Section: Discussionmentioning

confidence: 99%

Repair of Adult Hypospadias Under Local Anesthesia: The Technique and Outcomes

Kalkan¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Bu klinik çalışmada; distal hipospadiası olan erişkin olgularda lokal anestesi ile hipospadias onarım tekniği ve sonuçları sunuldu. Gereç ve Yön-tem: 2000Yön-tem: -2010 yılları arasında yaşları 20 ile 24 (Ort.: 21.3) arasında deği-şen 24 olguda lokal anestesi ile hipospadias onarımı yapıldı. Hipospadias tipi 11 olguda koronal, 13 olguda subkoronal idi. Tüm olgular sünnetli idi. Tüm olgularda tübülerize insize plate üretroplasti (TIPU) tekniği uygulandı. Anestesik madde olarak penis köküne cilt altına prilocain hidroklorür 20 mg/ml, üret-ra içerisine % 2 lidocain içeren 12,5 g. Jel kullanıldı. Olgular Görsel ağrı skalası ile ağrı yönünden kayıt edildi. Olgular ağrı, lokal anestezinin komplikasyonları, operasyon süresi, erken ve geç komplikasyonlar yönünden değerlen-dirildi. Bulgular: Tüm olgular operasyonu kolay tolere ettiler. Peroperatif visü-el ağrı skalası (VAS) ortalama 2,04 (0-4) olarak bulundu. Operasyon süresi 16 ile 35 dakika (Ort.: 24 dk.) idi. Bir olguda operasyon sırasında senkop gelişti. 3 olguda üretral fistül gelişti. Fistüller lokal anestezi ile kateter kullanmaksı-zın outpatient olarak onarıldı. Meatal darlık, kötü kozmetik görünüm gözlen-medi. Tartışma: Lokal anestezi ile TIPU tarzı hipospadias onarımının erişkin distal hipospadiaslı olgularda kabul edilebilir ağrı ile birlikte güvenle uygulanabilir olduğu gösterildi. Anahtar KelimelerErişkin; Hypospadias; Local Anestezi; Teknik; Visual Analog Ağrı Skalası Abstract Aim: In this study, we evaluated the outcomes of a hypospadias repair technique using local anesthesia in adult patients with distal hypospadias. Material and Method: Hypospadias repair was performed under local anesthesia in 24 cases of circumcised males from 2000-2010. The type of hypospadias was coronal in 11 cases and subcoronal in 13 cases. Tubularised incisedplate urethroplasty method was used in all of the patients. Subcutaneous prilocaine hydrochloride was administered into the root of the penis and 12.5 g of a gel containing 2% lidocaine was administered into the urethra as an anesthetic agent. The patients' pain levels were assessed using the Visual Analogue Scale (VAS). Patients were evaluated in terms of pain level, duration of the operation, and early and late complications. Results: All patients easily tolerated the operation, with a mean postoperative VAS pain assessment of 2.04 (0-4). The duration of the operation ranged between 16 and 35 min. One of the patients developed syncope during the operation. Urethral fistula was seen in three patients. No incidence of meatal stenosis or poor cosmetic appearance was observed. Discussion: Hypospadias repair under local anesthesia was demonstrated to be safely practicable with an acceptable degree of postsurgical pain in adult patients with distal hypospadias.

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Two in one: patient-controlled epidural analgesia (PCEA) to prevent erection and control pain in adult hypospadias-surgery patients

Cited by 5 publications

References 11 publications

Distal Hypospadias Repair in Adults: The Results of 97 Cases

Distal Hypospadias Repair in Adults: The Results of 97 Cases

Comparison of Epidural Dexmedetomidine Versus Ropivacaine Infusion Effectiveness in Preventing Erection Following Reconstructive Urethral Surgery: A Randomized Clinical Trial

Repair of Adult Hypospadias Under Local Anesthesia: The Technique and Outcomes

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