Office pediatric urologic procedures from a parental perspective

Objectives. To determine the parent perception of discomfort (PPD) in children receiving local anesthesia for the lysis of labial adhesions, meatotomy, and newborn circumcision; the parents' perceived outcome of these procedures; and the overall satisfaction of parents when these procedures are performed in the office. Methods. A confidential phone survey was given to 99 parent participants whose children had received local anesthesia for the lysis of labial adhesions (n = 14), meatotomy (n = 28), or newborn circumcision (n = 57). Parents in the labial adhesion and meatal stenosis groups were asked to rate their child's level of discomfort (PPD) during the procedure as mild (1), moderate (2), or severe (3), and those in the circumcision group were asked to use the same scale to rate their child's discomfort after the procedure. Parents were also asked whether they thought the procedure was successful and whether they were satisfied with their decision to have it done in the office using local anesthesia. Results. Among the labial adhesion, meatotomy, and circumcision groups, the mean PPD +/- SD was 1.64 +/- 0.75, 1.54 +/- 0.69, and 1.21 +/- 0.55, respectively. The observed procedures, lysis of labial adhesions and meatotomy, had a significantly higher PPD score (P = 0.005) than the unobserved procedure (circumcision). Parents reported good outcomes in 94 (94.9%) of 99 children, with 4 girls experiencing recurrent labial adhesions and 1 boy experiencing recurrent meatal stenosis. Overall, 95 (96.0%) of 99 parents stated that they were satisfied with their decision to have the procedure done in the office with local anesthesia. Of the remaining 4 parents, 3 parents in the circumcision group stated they would have preferred general anesthesia, and 1 parent in the labial adhesion group was undecided. Conclusions. The PPD is greater if the parent observes their child's procedure. However, office procedures using local anesthesia for the lysis of labial adhesions, meatotomy, and newborn circumcision are well accepted among the parent population. (C) 2000, Elsevier Science Inc.