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    Verbal anesthesia: How it’s used in urologic procedures

    ‘Conversational distraction’ offers clinical, efficiency benefits to patients and physicians

    Steven N. Gange, MDSteven N. Gange, MD Neil H. Baum, MDNeil H. Baum, MD Section Editor Christopher M. Gonzalez, MD, MBASection Editor Christopher M. Gonzalez, MD, MBA

    Dr. Gange is a men’s health urologist and clinical investigator with Summit Urology Group and Jean Brown Research in Salt Lake City. He is a faculty member, proctor, and consultant for NeoTract and an investigator for NxThera and Nymox. Dr. Baum is professor of clinical urology at Tulane Medical School, New Orleans, and author of “The Complete Business Guide for a Successful Medical Practice” (Springer, 2015). He is a faculty member, proctor, and consultant for NeoTract. Section Editor Christopher M. Gonzalez, MD, MBA, is professor and chairman of urology at University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland.


    A number of favorable patient and physician factors have led urologists to consider performing procedures in an office setting. The success of procedures conducted in this venue requires that patients have a safe and comfortable experience without impacting the quality of their outcome. Once established in this treatment pattern, the physician stands to gain efficiency, possible revenue enhancement, and overall satisfaction.

    This article will discuss the adjunctive role of verbal anesthesia in easing the urology patient’s in-office procedure experience.

    Many diagnostic and therapeutic urologic procedures can be performed easily and safely in the office, with limited anesthesia administration. In-office procedures offer many benefits to patients and also to physicians. While adult diagnostic flexible cystoscopy, vasectomy, and transrectal ultrasound-guided biopsy are almost uniformly performed in urology offices, other procedures such as neuromodulation, endoscopic injections, transurethral resection of bladder tumor, minimally invasive surgical therapy for BPH, are increasingly performed in the office setting, often under strict local anesthesia. Despite potential advantages, some urologists are hesitant to expand their in-office procedural offerings.

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    Patients appreciate some unique benefits of in-office procedures. The average patient is already comfortable in the office and with the office staff, and may perceive a surgical facility as intimidating. Typically, for procedures performed in the office, there is no required fasting period, no needle sticks for labs or IV placement, and less paperwork. From a financial standpoint, patient co-pays and out-of-pocket costs are typically lower for in-office procedures. Also, since many urologic procedures can be done under strict local anesthesia (without sedation), this allows patients with significant comorbidities to complete an in-office procedure with much lower risk. Finally, as opposed to strict post-anesthetic surgical facility requirements, many patients also enjoy the freedom of driving themselves home without an escort following a straightforward office procedure.

    From the urologist’s standpoint, being away from the office to conduct surgical cases seriously impairs one’s efficiency. Even when a day of OR cases begins and flows as scheduled, turnover time in the hospital or ambulatory surgery center results in excessive downtime, time spent away from tasks accumulating on the office EMR, and potential lost revenue (Am J Surg 2012; 204:23–7).

    Next: What is verbal anesthesia?


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    • [email protected]
      Good Morning: I'm curious as to whether more urologists are using male nurses in their practice as most urology patients are male. Having a male nurse along with male verbal anesthetists rather than a females for an intimate procedure would lend itself to making many male patients more comfortable as many men, are not comfortable being so intimately exposed in front of a woman other then their wife, but they won't say so because they don't want to be seen as being weak. It's a known fact male patients won't speak up for fear of being seen as weak and being mocked as such by the medical community. Having all males in the treatment room would also lend itself to making it easier for the male verbal anesthetist to strike up and keep a conversation going longer with his male patient whereby better keeping the patient's mind off of what's going on in the room. Verbal anesthesia has potential if it's used in conjunction with asking a patient are they comfortable with female staff being in the room and if not replacing the female staff with male staff. Verbal anesthesia on a male patient who is not comfortable to begin with being so intimately exposed in front of female staff won't mean a hill of beans to the him which in turn won't help his outcome. Regards, Raffie
    • UBM User
      I particularly found this article interesting in that I have been using this method for over 25 years. Although anecdotal, this method was extremely successful. A number of patients commented how the procedure done was not nearly as uncomfortable as they expected. There is no control group, randomization, or longitudinal aspect to this, none the less, it is nice to see an article on my method of additional anesthesia used during my entire career.