Office based urologic interventions: a safe and effective alternative to outpatient surgical procedures under anesthesia
Aznive Aghababian, BS, Sahar Eftekharzadeh, MD, MPH, Sameer Mittal, MD, MSc, Dawud Hamdan, BS, John Weaver, MD, MRCS, Dana Weiss, MD, Christopher Long, MD, Jason Van Batavia, MD, Mark Zaontz, MD, Stephen Zderic, MD, Thomas Kolon, MD, Douglas Canning, MD, Aseem Shukla, MD, Arun Srinivasan, MD, MRCS.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Background: Office based urologic interventions are often performed in children, but there is lack of literature describing their safety or efficacy. We hypothesize that office based urologic interventions are safe and effective for children and avoid unnecessary anesthesia. Methods: A retrospective data analysis was done on patients undergoing office based urologic interventions from 2014 to 2019. Interventions included circumcision, lysis of penile adhesion, division of skin bridges, lysis of labial adhesions, meatotomy and excision of benign lesion. Success was defined as a complete attempt in the office while failure includes any unsuccessful office attempts. Complications include 30-day ED visits, readmissions, cicatrix post circumcision, and recurrent skin bridge post division of skin bridge. Recurrent adhesions post penile adhesions, division of skin bridge, lysis of labial adhesions and recurrent stenosis post meatotomy were categorized as retreatment/recurrence and not included in the overall success measure. Results: We identified 2,955 office based interventions: 1,629 circumcisions (55%), 491 lyses of penile adhesions (17%), 320 division of skin bridges (11%), 128 lyses of labial adhesions (4%), 348 meatotomies (12%), and 39 excisions of benign lesions (1%) [Table 1]. Very few returned to the ER (N=6, 0.2%) within 30 days, and only one patient required readmission [Table 2]. There were 4 (0.2%) instances of cicatrix post circumcision and 6 (1.9%) recurrent skin bridges post division of skin bridge. The highest failure rate occurred after division of skin bridge, where 16 (5%) patients required a second attempt. Of the 16 attempts, 12 (75%) required anesthesia. All 11 out of 11 failed penile adhesions (2.2%) were due to skin bridges that were revealed while lysing penile adhesions, further requiring anesthesia. The rate of retreatment/recurrence was highest following lysis of labial adhesions (13.3%, p-value<0.05) followed by lysis of penile adhesions (5.1%). Of the total 54 patients with retreatment/recurrence, majority of the secondary interventions were completed in the office (N=48, 89%) while very few required general anesthesia (n=6, 11%). Excision of benign lesion had 100% success rate with no failures, complications or reintervention/retreatment. Conclusions: Office based urologic interventions are well tolerated with excellent safety and efficacy for children. Complications and recurrence of problems are universally low for these interventions. The higher rate of recurrence after lysis of labial adhesions has led to a reevaluation of the management algorithm for this diagnosis. 
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