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Local Anesthetics

Local anesthetics are among the most versatile drug classes in urology, with applications spanning twelve domains that together touch essentially every facet of functional and reconstructive practice: (1) intraurethral anesthesia for cystoscopy, catheterization, and urethral procedures; (2) periprostatic nerve block for prostate biopsy; (3) intravesical instillation for IC/BPS; (4) penile nerve block for circumcision and penile surgery; (5) vasectomy anesthesia; (6) topical treatment of premature ejaculation; (7) vulvodynia / vestibulodynia management; (8) pudendal nerve block and pelvic-floor trigger-point injection for pelvic pain; (9) transversus abdominis plane (TAP) block and wound infiltration for perioperative analgesia; (10) retrograde ureteral stent placement under local anesthesia; (11) urodynamic testing; and (12) hydrodistension for IC/BPS under local anesthesia.[1][2][3] Lidocaine is the dominant agent, but bupivacaine, ropivacaine, prilocaine, and levobupivacaine each occupy specific urologic niches.

For related classes, see Topical compounded agents, NSAIDs and analgesics, Gabapentinoids, and Tricyclic antidepressants.

Agents at a glance​

The principal agents in the table are amide-type local anesthetics (tetracaine and oxybuprocaine, mentioned below, are esters) — they bind the α-subunit of voltage-gated sodium channels from the axoplasmic side, blocking action-potential generation in sensory nerve endings. Onset tracks with pKa (more un-ionized drug at physiologic pH = faster membrane penetration); duration tracks with protein binding and lipid solubility.[2][3][4]

AgentOnsetDurationRelative potencyDose boundaryPrimary urologic role
Lidocaine3–5 min1–2 h1×Injection and urethral-jelly limits differ; see safety sectionUrethral jelly, PNB, intravesical, wound infiltration, pelvic-floor trigger points[2]
Bupivacaine5–10 min4–8 h4×Product-, route- and patient-specificPeriprostatic block, pudendal block, TAP block, wound infiltration[3]
Ropivacaine (S-enantiomer)5–10 min4–8 h3×Infiltration and major-block ranges differTAP block, wound infiltration, analgesic-eluting catheters; less cardiotoxic than bupivacaine[3][5][6]
PrilocaineRapid1–2 h1×Follow the topical product’s amount/site limitsEMLA (with lidocaine); PE spray (Fortacin)[4]
Levobupivacaine (S-enantiomer)IntermediateLong~4×Product-, route- and patient-specificIntravesical instillation for cystoscopy[7]

Three practical principles carry across the applications below:

  • Alkalinization increases efficacy — adding sodium bicarbonate raises pH, increases the un-ionized fraction, and improves urothelial penetration. This is the basis for alkalinized intravesical lidocaine for IC/BPS, and also increases systemic absorption.[8][9]
  • Ropivacaine may offer a pharmacologic safety margin over bupivacaine, but both can cause LAST. Choice and dose depend on the block, patient and cumulative exposure; comparative pharmacology does not establish a universally preferred large-volume regimen.[5][6]
  • Penile epinephrine requires a specific risk assessment. A 95-patient series attributed no complications to its anesthetic, but reported small-area skin necrosis in 13%; it does not prove zero ischemic risk or overturn product precautions.[10]

Intraurethral anesthesia — cystoscopy and catheterization​

Intraurethral cocaine in 1884 was the first local anesthetic used in urology and arguably launched the specialty as an outpatient discipline.[1]

Lidocaine HCl jelly 2% is FDA-approved for prevention and control of pain in procedures involving the male and female urethra and for topical treatment of painful urethritis.[2]

Dosing (FDA label)[2]​

ApplicationDose
Male urethra — pre-cystoscopy~15 mL instilled until tension → penile clamp at corona → additional 15 mL if needed (up to 30 mL / 600 mg total); clamp 5–10 min before scope entry
Female urethra3–5 mL (60–100 mg)
Catheterization5–10 mL (100–200 mg)
Maximum in 12 h600 mg

Evidence in flexible cystoscopy — statistically real, clinically modest​

  • Raskolnikov 2019 (systematic review + meta-analysis, 12 RCTs, n = 1,549 men) — intraurethral lidocaine vs plain lubricant: SMD −0.22 (95% CI −0.39 to −0.05), pooling 10-point VAS measurements; SMD is a standardized effect, not a 0.22-point VAS difference; effect greater with longer dwell time[11]
  • Aaronson 2009 (meta-analysis, 4 RCTs, n = 411 men) — lidocaine-gel patients were 1.7× more likely to avoid moderate-to-severe pain vs plain lubricant (OR 1.7; 95% CI 1.1–2.8)[12]
  • Desai 2025 multi-site pilot (n = 190) — lidocaine dwell time ≤10 vs >10 min did not change outcomes; real-time visualization and patient-selected music were associated with lower pain and anxiety[13]
  • Desai 2025 expert review (53 RCTs synthesized) — no single intervention eliminates cystoscopy discomfort; multimodal approaches (irrigation pressure, music, visualization, intraurethral lidocaine) provide the best outcomes[14]

Alternative regimens for cystoscopy​

  • Intracavitary levobupivacaine (Pehlivanoğlu 2021 RCT, n = 100) — 4–10 mL of 5 mg/mL mixed to 30 mL and instilled before rigid cystoscopy produced significantly lower VAS than standard lidocaine gel, with higher patient satisfaction and no drug-related side effects[7]
  • Tetracaine jelly + IV anesthesia (Bai 2025 RCT, n = 60) — reduced propofol requirements, shortened procedure time, and improved postoperative oxygenation vs IV anesthesia alone[15]
  • Oxybuprocaine gel (Dong 2022 RCT, n = 192) reduced male-catheterization pain vs liquid paraffin (VAS 32 vs 39 mm; p < 0.05)[16]
  • Ropivacaine-eluting catheter (Jung 2025 RCT, n = 60) — 0.5% ropivacaine released at 2 mL/hr cut catheter-related bladder discomfort from 65% → 21% after urogynecologic surgery (p = 0.018) with no adverse events[17]
  • Pediatric catheterization (Poonai 2015 RCT, n = 133) — intraurethral lidocaine did not reduce pain in children 0–24 months vs non-anesthetic lubricant, and caused significantly more pain during instillation — this trial does not support routine use for infant catheterization[18]

Urodynamics​

  • Özel 2018 RCT — 2% lidocaine gel significantly reduced pain during cotton-tipped swab test (1.3 vs 3.6; p < 0.001)[19]

Periprostatic nerve block — prostate biopsy​

Current EAU guidance recommends ultrasound-guided periprostatic block and supports local anesthesia for transperineal biopsy with additional perineal skin/deeper-tissue infiltration. Intrarectal cream alone is inferior to periprostatic injection. The historical TRUS network ranking below does not select the biopsy route or establish that all men need sedation; calculate the combined local-anesthetic dose.[66]

Network meta-analysis (Kim 2019, 47 RCTs) ranked methods for TRUS-guided biopsy; PNB means periprostatic nerve block, PPB pelvic plexus block, IRLA intrarectal local anesthetic and IPLA intraprostatic local anesthetic:[20]

  1. PNB + IV sedation (highest network rank, with additional monitoring requirements)
  2. Spinal anesthesia
  3. PPB + intrarectal local anesthetic (IRLA)
  4. PNB + intraprostatic local anesthetic (IPLA)
  5. PPB alone
  6. PNB + IRLA
  7. PNB alone (lower in this network ranking, but remains a guideline-supported technique)

In the office, PPB + IRLA, PNB + IPLA, and PNB + IRLA were among the studied combinations; feasibility depends on local expertise and monitoring.

Agent selection (Li 2017, 46-RCT meta-analysis):[21]

  • Lidocaine 1–2% — standard for PNB; rapid onset, short duration[22]
  • Bupivacaine 0.25–0.5% — effective periprostatic anesthesia (VAS 2.04 vs 4.46 for no anesthesia; p < 0.05)[23]
  • Lidocaine + bupivacaine combination — attenuates the 1-hour rebound pain seen with lidocaine alone (rebound +0.09 vs +0.9; p = 0.0006) with later pain-score differences reported; this does not mean that nerve blockade lasts a week. Routine mixing is not recommended in the current bupivacaine label, and toxicities are additive[24]
  • EMLA (prilocaine + lidocaine) cream intrarectally is more effective than lidocaine gel when combined with PNB[25]
  • Intraprostatic local anesthesia (IPLA) + PNB is superior to PNB alone[26]
  • Tramadol + lidocaine PNB — lower pain scores (3.6) than lidocaine alone (4.6) or tramadol alone (5.4)[27]

PNB lateral to the neurovascular bundle has better analgesic effect than at the prostate apex.[21]

Intravesical lidocaine — IC/BPS​

AUA 2022 IC/BPS guideline (Grade B): intravesical lidocaine may be administered for IC/BPS. Lidocaine significantly improves symptoms in the short term (<2 weeks after a course of therapy); sustained benefit is seen in a subset of patients.[8]

Key principles and evidence:

  • Alkalinization increases urothelial penetration and probable efficacy, at the cost of greater systemic absorption; no head-to-head trial compares alkalinized vs plain intravesical lidocaine[8]
  • Lidocaine + heparin and lidocaine + PPS combinations show greater bladder-pain and urgency reduction than lidocaine alone[8]
  • Proposed effects beyond anesthesia (Henry 2015) include anti-inflammatory mechanisms. A response may support a bladder contribution to pain, but is not a validated stand-alone confirmation of the pain generator[28]
  • Investigational LiRIS pilot — a continuous lidocaine-releasing intravesical device designed for 2-week retention (Nickel 2012, n = 16 women meeting NIDDK IC criteria). Both 200 mg and 650 mg doses were well tolerated. Clinically meaningful reductions in pain, urgency, and frequency; Hunner lesions resolved in 5 of 6 subjects with baseline lesions; 64% responder rate at day 14, sustained at 64% two weeks later, with pain reduction maintained several months after device removal[29]
  • Later LiRIS trials (Evans 2021): two multicenter placebo-controlled studies, with 59 and 131 treated women, did not meet their primary pain endpoint four weeks after removal (Hunner-lesion study p=0.142 for two active devices versus two placebo devices; non-Hunner study p=0.505). There was no clear Hunner-lesion reduction. The early pilot does not establish clinical efficacy.[70]
  • Investigational TRG-100 — an open-label pilot of intravesical sustained-release lidocaine + oxybutynin (Raisin 2023) reported improvement in VAS, voiding frequency, and O'Leary-Sant scores across IC/BPS, OAB, and stented patients[30]
  • 2025 global consensus lists intravesical lidocaine among the core available instillation therapies alongside DMSO, oxybutynin, and GAG-replenishment agents[31]

See Intravesical IC/BPS agents and IC/PBS for the broader intravesical armamentarium.

Penile nerve block — circumcision and penile surgery​

Techniques — dorsal penile nerve block (DPNB; injection at the base of the penis beneath Buck's fascia targeting the dorsal nerves), ring block (subcutaneous circumferential at the base), and the combination (most complete anesthesia).

APS/ASRA/ASA postoperative-pain guideline (2016) — strong recommendation: "Clinicians should use topical local anesthetics in combination with nerve blocks before circumcision" (moderate-quality evidence).[32]

LAST in penile nerve block — systematic review of case reports (Park 2025, 19 patients across 11 reports):[33]

  • 73.7% of cases occurred in infants <1 year — a predominance among reported cases, not an incidence comparison
  • Lidocaine predominated in overdose cases; bupivacaine in presumed inadvertent intravascular absorption
  • Seizures and cardiovascular collapse were the dominant presentations
  • Calculate cumulative dose, inject slowly in increments, aspirate, monitor and have rescue resources; negative aspiration does not exclude intravascular injection

The Schnabl 95 series does not establish freedom from ischemic injury. Current bupivacaine/epinephrine labeling advises carefully restricted quantities in the penis and other areas with limited/compromised blood supply; assess vascular disease and the exact technique/formulation.[60][10]

Vasectomy anesthesia​

AUA 2026 vasectomy guideline, Statement 9 (Moderate / Grade C): use local skin infiltration by needle and/or jet injector. Topical anesthetic can lessen injection pain but cannot substitute for perivasal anesthesia. Small needles and buffered lidocaine may improve tolerability; sedation is individualized for anxiety or anticipated difficult vas isolation. Statement 10 favors nonopioid oral postoperative analgesia.[34]

Technique comparison (Aggarwal 2009, n = 323):[35]

  • Local infiltration anesthesia (LIA) + spermatic cord block (SCB) had the lowest procedural pain in this nonrandomized comparison
  • Anesthesia-related pain: LIA + SCB (1.7) vs LIA alone (3.3; p < 0.001)

Mini-needle technique (Shih 2010):[36]

  • 1-inch 30-gauge needle with ~2 mL 2% lidocaine without epinephrine, injected directly at the vas
  • Mean VAS during anesthesia 1.5 (95% CI 1.3–1.7); during procedure 0.6 (0.5–0.7)
  • Patients consistently report less pain than anticipated

Topical local anesthetics — premature ejaculation​

The AUA/SMSNA guideline lists topical penile anesthetics, daily SSRIs and on-demand clomipramine or dapoxetine where available among first-line PE medicines (Strong / Grade B). Dapoxetine is an SSRI, not an SNRI; Fortacin is the European-labeled lidocaine/prilocaine spray for primary PE in adult men.[63][64][37]

Fortacin (lidocaine 150 mg/mL + prilocaine 50 mg/mL)​

  • European approval for lifelong PE; not FDA-approved in the US
  • Label dose: three sprays to the glans; wipe off excess after five minutes before intercourse. Maximum three doses in 24 hours, at least four hours apart. Avoid polyurethane condoms; the label lists compatible alternatives. Review partner allergy, methemoglobinemia risk and conception/pregnancy precautions.[63]
  • Wyllie & Powell 2012 review of two pivotal trials (pooled intention-to-treat n=539) — geometric mean IELT 0.58 → 3.17 min over 3 months, approximately 3.3 times the placebo final value (placebo 0.56→0.94 min), not a 3.3-fold change from its own baseline (p < 0.001)[38]
  • Cai 2023 dose-finding (n = 91) — three sprays 5 min before intercourse optimized both IELT (221 ± 3.4 sec) and PEDT (7.7 ± 0.3) with the same safety profile as other regimens[39]
  • Boeri 2022 real-life use (n = 198) — 92.9% tried it, 66.4% regular use at 6 months, 26.8% continued at 12 months; significant IELT and PEDT improvement sustained at both timepoints[40]

EMLA (lidocaine 2.5% + prilocaine 2.5%) — off-label​

  • Applied to the glans 15–30 min before intercourse, then wiped off or covered with a condom
  • Atan 2006 RCT (n = 84) — EMLA monotherapy effectiveness 77.3% vs placebo 40% (reported significant comparison); a nonsignificant comparison with sildenafil + EMLA does not establish equivalence[41]
  • Adverse effects: loss of penile sensitivity, erectile difficulty, and female genital anesthesia from partner transfer (use condom protection)[42]

Lidocaine 5% spray — off-label​

  • Abu El-Hamd 2021 RCT (n = 150) — lidocaine 5% spray 10–20 min before intercourse significantly improved AIPE, IELT, and intercourse frequency vs placebo (all p = 0.0001)[43]

Topical delivery can limit systemic exposure, but does not guarantee absence of systemic effects. Partner transfer, local numbness/burning and formulation-specific precautions matter.[37]

Vulvodynia and vestibulodynia​

Lidocaine has mixed, indication-specific evidence. Detail lives in Topical compounded agents:

  • Zolnoun’s 2003 uncontrolled series reported intercourse possible in 76% versus 36% at baseline; it was not a placebo-controlled efficacy trial.[44]
  • Selected breast-cancer survivors with vestibular dyspareunia benefited from 4% aqueous lidocaine in a small RCT discussed by ACOG; this cannot be generalized to every vulvar-pain phenotype.[45]
  • Foster 2010 (133 women) found no significant primary tampon-pain benefit from 5% lidocaine, oral desipramine or their combination versus placebo.[67]
  • Morin 2021 (212 women) found multimodal physical therapy superior to overnight 5% lidocaine for provoked vestibulodynia, with a 1.8/10 between-group intercourse-pain difference after treatment and benefit maintained at six months.[68]
  • UPDATe (NCT03844412) is completed (209 enrolled;170 paired primary pain observations); results posted March 19, 2026 showed nonsignificant four-arm comparisons for tampon pain and SF-MPQ change. These are registry results, not proof of equivalence or a peer-reviewed positive efficacy trial.[46][69]

Pudendal nerve block and pelvic-floor trigger-point injections​

Pudendal nerve perineural injections (PNPIs)​

Local-anesthetic pudendal blocks can contribute to diagnosis and short-term symptom management. Routine steroid addition is not supported: Labat’s multicenter 201-person randomized trial found three-month response in 11.8% with anesthetic alone versus 14.3% in the steroid-containing groups (p=0.62). Response meant a ≥30-point improvement on a 100-point pain scale.[65] The following uncontrolled studies do not overturn that comparison:

  • Antolak 2016 (n = 53 men) — PNPIs significantly reduced pain (p < 0.001); quality measures for proper injection technique were defined[47]
  • Fluoroscopy-guided transgluteal pudendal block (Levin 2024, n = 101) — 49.4% achieved ≥30% pain relief at 2 weeks with reduced medication use and improved ADLs[48]
  • CT-guided pudendal block (Ly 2019, n = 91) — positive MR-neurography findings predicted better response in men (p = 0.005); women had better overall response[49]

Pelvic-floor trigger-point injections​

ACOG CPP Practice Bulletin (2020) — recommended: trigger-point injections of saline, anesthetic, steroid, or combinations are recommended to improve pain and function in myofascial CPP. Benefit appears regardless of injectant, raising the possibility that needle insertion itself exerts a substantial effect.[50]

  • Hui 2020 (n = 8 men with UCPPS) — ultrasound-guided 1% lidocaine to iliococcygeus, pubococcygeus, and puborectalis with concurrent pudendal-nerve hydrodissection reduced VAS 3.3 → 1.8 (p < 0.05)[51]

TAP block and wound infiltration in urologic surgery​

TAP block — meta-analytic evidence​

  • Zayed 2021 (20 RCTs, n = 1,239) — TAP block significantly reduced postoperative pain at all timepoints (MD 0.55–1.13 at rest; 0.74–1.32 on movement) and cut 24-h opioid consumption by 12.25 mg morphine equivalents (p < 0.001)[52]
  • Zako 2025 (123 RCTs, comprehensive meta-analysis) — TAP block superior to both placebo and local wound infiltration for pain at 6, 12, and 24 h and for 24-h morphine use; not superior to epidural (except at 12 h) or intrathecal morphine[53]

TAP vs local anesthesia — the UROTAP trial​

Rosen 2022 (RCT, n = 143) compared robot-assisted TAP (RTAP), ultrasound-guided TAP (UTAP), and local anesthesia (LA) for RARP and RAPN. UTAP did not demonstrate superiority to simple wound LA for pain control. RTAP and LA were faster to deliver than UTAP (2.5 vs 6.25 min; p < 0.001).[54] The practical takeaway: for minimally invasive urologic surgery with modern ERAS pathways, well-executed wound infiltration may be as effective as an ultrasound-guided TAP at a fraction of the setup time.

Wound infiltration + TAP for RARP​

Cacciamani 2019 RCT (n = 100) — wound infiltration combined with US-TAP using ropivacaine 0.35% reduced mean NRS within 12 h (1.6 vs 2.6; p = 0.02), opioid use (3.5% vs 18.6%; p = 0.01), LOS (4.27 vs 4.72 d; p = 0.04), and prokinetic requirements (21% vs 72%; p < 0.001).[55]

See ERAS perioperative pharmacology for the broader multimodal framework.

Retrograde ureteral stent placement under local anesthesia​

EAU Endourology systematic review (Pischetola 2025, 1,725 patients / 1,873 ureteral units):[56]

  • Overall success: 89%; failure 11%
  • Complications 8.68% (predominantly Clavien I–II at 5.94%; III–IV at 2.74%)
  • Lidocaine jelly is the primary local anesthetic, with adjunct pharmacology in some series
  • Fluoroscopic guidance in 86.3%
  • Significant cost savings vs general anesthesia; patient satisfaction generally high with willingness to repeat
  • Clinical interpretation: selected patients may undergo stenting under local anesthesia, but pooled selected-series results do not establish universal office suitability. Infection, obstruction severity, anatomy, tolerance and rescue/transfer capability determine the setting

Hydrodistension under local anesthesia for IC/BPS​

The AUA guideline places cystoscopy with hydrodistension under general or regional anesthesia;[8] local-anesthetic approaches have been studied for selected patients:

  • Aihara 2009 (n = 30) — hydrodistension 10 min after 10 mL 4% lidocaine was feasible and safe; 71% therapeutic efficacy at 1 month, median efficacy period 20 weeks, no admissions[57]
  • Electromotive drug administration (EMDA) of lidocaine (Rose 2005, n = 21) allowed more office-based distensions to completion than simple alkalinized instillation (7/11 vs 4/10) and greater bladder expansion (135% vs 70% of cystometric capacity)[58]
  • Transvaginal trigonal block with bupivacaine + xylocaine (Hoke 2017, n = 106) did not add therapeutic benefit over hydrodistension alone — both groups improved[59]

Safety — Local Anesthetic Systemic Toxicity (LAST)​

LAST is the most serious adverse event in this drug class and is particularly relevant in urology given mucosal absorption and the large volumes occasionally used.[2][33]

Urologic-specific risk factors:

  • Mucosal application — urethral and bladder mucosa absorb local anesthetics far more rapidly than intact skin; the FDA lidocaine label specifies that absorption varies with concentration, total dose, site, and duration[2]
  • Alkalinized intravesical instillation — increases both efficacy and systemic absorption[8]
  • Repeated doses / continuous delivery (e.g., analgesic-eluting catheters, LiRIS) — slow accumulation can produce meaningful plasma concentrations; reduce doses in the debilitated, elderly, and acutely ill[2]
  • Penile block in infants <1 year — highest-risk LAST population; bupivacaine is the most common culprit[33]

Formulation- and route-specific dose limits​

There is no single maximum-dose table valid for every route. Calculate the total milligrams from all gels, blocks and infusions, account for additive toxicity, and use the exact product’s label plus an anesthesia plan. A listed limit is not a target or a guarantee against LAST.[2][3][60][61]

Product / settingLabel boundary and limitation
Plain lidocaine injection, normal healthy adult4.5 mg/kg, generally no more than 300 mg; use lower doses when required by patient or block characteristics[61]
Lidocaine 2% urethral jellySeparate adult urethral directions above; no more than 600 mg in 12 h. This is not permission to inject 600 mg or to ignore other lidocaine exposure[2]
Plain bupivacaine infiltration / peripheral block in adultsLabel table allows up to 175 mg for these routes, individualized; total daily exposure must not exceed 400 mg. Route-specific restrictions and cumulative toxicity still apply[60]
Ropivacaine infiltrationLabel range up to 200 mg; major-block and epidural ranges differ. The reported 770 mg/24 h experience concerns intraoperative block plus postoperative epidural infusion, not a single injection or a general office ceiling[3]
Prilocaine-containing creams/sprays and levobupivacaineUse the actual jurisdiction/product label. A generic mg/kg injection ceiling must not be transferred to genital cream or spray use[63]

Recognize and treat LAST​

Stop administration, call for help and support oxygenation/ventilation. Neurologic symptoms can include tinnitus, circumoral numbness, altered consciousness or seizure; cardiovascular collapse can occur without a clear prodrome. Follow the ASRA LAST checklist, which differs from standard ACLS: consider 20% lipid emulsion early, use benzodiazepines preferentially for seizures, and use smaller epinephrine doses when indicated. The checklist also identifies resuscitation drugs to avoid and post-event observation intervals. Keep it and a stocked rescue kit immediately available.[62]

Methemoglobinemia is a separate toxicity, particularly relevant to prilocaine and susceptible patients/oxidizing-drug combinations; unexplained cyanosis needs urgent assessment rather than assuming it is ordinary hypoxemia.[2][63]

Clinical positioning​

  • Choose the agent, formulation, route and cumulative dose together. Mucosal gel, infiltration, peripheral block and epidural infusion are not interchangeable dosing contexts.
  • Cystoscopy lidocaine benefit is modest on average; combine respectful explanation, lubrication and other patient-centered measures without promising a painless procedure.[11][13][14]
  • Intravesical lidocaine is an AUA IC/BPS option for short-term relief. A response does not by itself confirm the diagnosis; experimental delivery systems require their own efficacy evidence.[8][28][70]
  • For robotic procedures, UROTAP did not show superior analgesia with TAP over wound infiltration and stopped early. This supports considering simpler infiltration, but is not proof that techniques are equivalent in every operation.[54]
  • Use current product precautions for penile blocks and ready access to LAST rescue; neither a negative aspiration nor a dose below a table limit excludes toxicity.[33][60][62]

See Also​

References​

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2. Sentiss. Lidocaine hydrochloride jelly 2%: prescribing information. DailyMed. Accessed September 12, 2026.

3. Ropivacaine hydrochloride injection: prescribing information. DailyMed. Accessed September 12, 2026.

4. McClellan KJ, Faulds D. "Ropivacaine: an update of its use in regional anaesthesia." Drugs. 2000;60(5):1065–1093. doi:10.2165/00003495-200060050-00007

5. Zink W, Graf BM. "Benefit-risk assessment of ropivacaine in the management of postoperative pain." Drug Saf. 2004;27(14):1093–1114. doi:10.2165/00002018-200427140-00003

6. Kuthiala G, Chaudhary G. "Ropivacaine — a review of its pharmacology and clinical use." Indian J Anaesth. 2011;55(2):104–110. doi:10.4103/0019-5049.79875

7. Pehlivanoğlu M, Tavukçu HH, Akça O, et al. "Efficiency of intracavitary levobupivacaine infusion for pain management during cystoscopic procedures: a randomised study." Int J Clin Pract. 2021;75(7):e14164. doi:10.1111/ijcp.14164

8. Clemens JQ, Erickson DR, Varela NP, Lai HH. "Diagnosis and treatment of interstitial cystitis/bladder pain syndrome." J Urol. 2022;208(1):34–42. doi:10.1097/JU.0000000000002756

9. Parsons CL, Zupkas P, Proctor J, et al. "Alkalinized lidocaine and heparin provide immediate relief of pain and urgency in patients with interstitial cystitis." J Sex Med. 2012;9(1):207–212. doi:10.1111/j.1743-6109.2011.02542.x

10. Schnabl SM, Herrmann N, Wilder D, Breuninger H, Häfner HM. "Clinical results for use of local anesthesia with epinephrine in penile nerve block." J Dtsch Dermatol Ges. 2014;12(4):332–339. doi:10.1111/ddg.12287

11. Raskolnikov D, Brown B, Holt SK, et al. "Reduction of pain during flexible cystoscopy: a systematic review and meta-analysis." J Urol. 2019;202(6):1136–1142. doi:10.1097/JU.0000000000000399

12. Aaronson DS, Walsh TJ, Smith JF, et al. "Meta-analysis: does lidocaine gel before flexible cystoscopy provide pain relief?" BJU Int. 2009;104(4):506–510. doi:10.1111/j.1464-410X.2009.08417.x

13. Desai AP, Basak RS, Lotan Y, et al. "Feasibility and outcomes of interventions to reduce cystoscopy discomfort: a multi-site pilot study." BJU Int. 2025. doi:10.1111/bju.16794

14. Desai AP, Smith AB, Lotan Y. "Guidance for avoiding patient pain and discomfort during transurethral cystoscopy." Expert Rev Med Devices. 2025. doi:10.1080/17434440.2025.2579582

15. Bai W, Luo D, Wurige M, Xiao B, Li J. "Research on the use of tetracaine hydrochloride jelly surface anesthesia in combination with intravenous anesthesia for pain-free cystoscopy." Front Med. 2025;12:1653269. doi:10.3389/fmed.2025.1653269

16. Dong Z, Qu X, Zhang L, et al. "Efficacy and safety of oxybuprocaine hydrochloride gel in alleviating pain during male urethral catheterization: a single-center randomized controlled study." Int J Clin Pract. 2022;2022:5734387. doi:10.1155/2022/5734387

17. Jung YJ, Lee SW, Lee Y, et al. "Efficacy and safety of analgesic-eluting urethral catheter after urogynecological surgery: a prospective randomized controlled trial." Sci Rep. 2025. doi:10.1038/s41598-025-30343-4

18. Poonai N, Li J, Langford C, et al. "Intraurethral lidocaine for urethral catheterization in children: a randomized controlled trial." Pediatrics. 2015;136(4):e879–e886. doi:10.1542/peds.2015-1852

19. Özel BZ, Sun V, Pahwa A, Nelken R, Dancz CE. "Randomized controlled trial of 2% lidocaine gel versus water-based lubricant for multi-channel urodynamics." Int Urogynecol J. 2018;29(9):1297–1302. doi:10.1007/s00192-018-3576-8

20. Kim DK, Lee JY, Jung JH, et al. "What is the most effective local anesthesia for transrectal ultrasonography-guided biopsy of the prostate? A systematic review and network meta-analysis of 47 randomized clinical trials." Sci Rep. 2019;9(1):4901. doi:10.1038/s41598-019-41412-w

21. Li M, Wang Z, Li H, et al. "Local anesthesia for transrectal ultrasound-guided biopsy of the prostate: a meta-analysis." Sci Rep. 2017;7:40421. doi:10.1038/srep40421

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