Evaluating Patient Tolerability and Success for Penile and Scrotal Urologic Procedures Under Conscious Sedation: A Prospective Study

Background:

The current standard of care for the vast majority of urological procedures is the administration of general anesthesia, spinal anesthesia, or anesthesia-delivered sedation - requiring the operating room. However, this poses significant challenges associated with operating room costs, resources, and patient wait times. Given lengthy surgical backlogs, priority is focused on more acute conditions such as malignancies that require immediate intervention. Procedures for non-acute conditions, such as penile and scrotal procedures, have wait times that can exceed six months. Since most treatment for penile and scrotal cases tends to be surgical intervention, delays in these procedures may significantly negatively impact patients' sexual health, relationships, mental health, and quality of life. The ability to perform these procedures outside of the operating room using local anesthesia with or without conscious sedation may significantly reduce patient wait times and the costs of surgical intervention. Furthermore, the use of conscious sedation would allow for faster post-operative recovery, shorter procedural times, and decreased risks/side effects associated with general anesthesia.

Fields such as plastic surgery have successfully transitioned certain procedures into a clinic- based setting and the field of urology had also shown a similar interest. The investigators research team has been at the forefront of this transition - previously demonstrating the efficacy of distal ureteroscopy under nursing administered conscious sedation and other common urologic procedures. However, these studies were limited as they did not examine invasive scrotal and penile procedures, which have an extraordinary impact on the sexual health of patients.

Significance:

This project will provide evidence on the efficacy and characteristics of successful penile and scrotal procedures conducted under the administration of local anesthesia with or without conscious sedation. The findings of this study will help transition additional urological procedures into a clinic-based setting safely: improving the sexual and mental health of patients while decreasing cost, wait times, procedure duration, recovery times, and anesthetic-related complications.