(284) A Systematic Review of Loco-sedative Anesthesia for Penile and Scrotal Surgery
Bibliographic record
Abstract
Abstract Introduction The current standard of care for patients undergoing the majority of scrotal and penile procedures is to administer general or spinal anesthesia. The use of general or spinal anesthesia can lead to several complications, long wait times and is not feasible in many rural and remote areas. Objective The objective of this study is to perform a systematic review of the characteristics and outcomes of conscious sedation and local anesthesia for penile and scrotal urologic procedures. Methods A systematic search was conducted on PubMed, and Scopus databases following PRISMA criteria from inception to August 2021. Articles were included if they were prospective, randomized or non-randomized controlled trials that used local anesthetic or conscious sedation for penile or scrotal interventions. Additionally, included studies provided primary data on the use loco-sedative anesthesia and the efficacy and complications from the procedures. Results Nine articles with 4511 patients were included in the study. Procedures examined included vasectomies, adult circumcisions, varicocelectomies, urethrocutaneous fistula repair, microepididymal sperm aspiration and testicular sperm extraction. Of the studies that reported age, the mean patient age was 29.3 years old. The most common anesthetic and analgesic relief was the use of local anesthetic with 1% lidocaine. Only one study used conscious sedation whereas the rest used local anesthetics. However, there was significant heterogeneity in the type of local or conscious sedation method and whether there was a combination was used. 44.4% of the studies used the visual analog scale (VAS) for their primary endpoint. All the studies reported 100% successful procedures with no sedative complications. Conclusions Given the high efficacy rates, loco-sedative anesthesia is a promising technique for penile and scrotal urologic interventions. However, the current body of literature has limited data on a wider array of procedures. Further controlled studies examining the use of loco-sedative anesthesia for a larger variety of penile and scrotal interventions are recommended. This review also demonstrates the significant heterogeneity on how sedation may be assessed and the variety of local anesthetics that can be used to substitute for general or spinal anesthesia. Disclosure No
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.035 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.008 |
| Bibliometrics | 0.013 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".