Endoscopic surgery in day hospital using bladder and urethral anesthesia with EMDA

To assess the suitability of EMDA local anaesthesia for invasive procedures on lower urinary tract in one day surgery treatment.The deep penetration of lignocaine into the bladder wall was attained by catheters, electrodes and electric current generators using revised electrochemical principles. Since 1994 203 patients with transitional cell carcinoma of the bladder underwent TURBT and 70 patients with bladder neck or prostatic obstruction underwent TURP, TUIP, TULAP; 20 patients underwent miscellaneous procedures: in 34 patients the procedures were combined. The patients' age was within 20 and 90 years (mean age 67.3). The procedures were performed in a single small endoscopic theatre annexed to the Urology Ward. A standard rigid resectoscope was used as well as a standard electrocautery (360 kHz) or a mega frequency low temperature Vesalius generator (4 MHz). Most patients received a premedication and some of them a light sedation when necessary, but all of them were fully conscious and able to complete an assessment using a simple pain scale.8 out of 273 patients (3%) considered pain intolerable and other 11 (4%) reported painful but tolerable sensation, and the remaining 254 patients referred absent or minimal discomfort. Most of the patients were able to walk back to their room and go home in the evening. Those who had no chance of going back home were admitted for the night as well as those who had no assistance at all at home or those who had high probability of haemorrhage. Side effects were minimal and not related to local anesthesia: the serum lignocaine levels measured in 4 patients were innocuous. All patients experienced some tingling and reddening at the skin site of the dispersive electrode fading in a few hours.Local anaesthesia by using EMDA proved to be effective for most invasive endoscopic procedures in the lower urinary tract and suitable for patients undergoing day hospital surgery.