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Enhancing Efficiency and Cost-Effectiveness through Local Anesthetic Minor Urological Procedures: Procedure Room Setting

Ko Ko Zayar Toe

Ko Ko Zayar Toe, Abdullatif Aydin, Mohamed Abouelenein, Hadi Kashif, Benjamin Swain, Katherine Guest, Francesca Kum, Sanjith Gnanappiragasam, Paul Sturch, Maria Satchi, Kawa Omar
King's College Hospital, London, United Kingdom



This retrospective study aims to assess the feasibility and tolerability of minor urological operative procedures performed under local anaesthesia, focusing on the cost-effectiveness and potential reduction of National Health Service (NHS) waiting list backlog.

Materials and Method:

A weekly half-day “Minor Ops” clinic was initiated in outpatient setting to overcome the long Day Surgery waiting lists for benign penoscrotal procedures and flexible cystoscopic biopsies. The clinic was run by a registrar and Core Surgical Trainee, with a supervising consultant present. Approximately, 3 clinics were conducted per month. Data was retrieved and analysed retrospectively from April,2021 to December,2022.


A total of 52 clinics were conducted over the course of 20months. The study included 113 patients, aged 20 to 93 (mean:52) who underwent circumcision(n=29), frenuloplasty(n=22), excision of penoscrotal lesions(n=16), vasectomy(n=12), and flexible cystoscopic biopsy and/or cystodiathermy (n=34). Patients who underwent the latter waited a mean of 35 days(2-181) compared to patients who underwent benign penoscrotal procedures 104 days(14-258). Of the 67 patients for penoscrotal surgery, 96% demonstrated high tolerance of local anesthesia. Only three procedures (2 circumcisions and 1 frenuloplasty) were canceled on the day due to pain.


This study emphasizes the urgency of addressing the NHS waiting list backlog. Shifting towards incorporating penoscrotal surgeries into minor operations not only proves feasible and well-tolerated but also emerges as a cost-effective strategy compared to conventional day surgery units. Implementing these changes could significantly enhance resource allocation and streamline the delivery of NHS services.