© 2022 Elsevier Inc.Objective: To assess feasibility and efficacy of local topical urethral anesthesia at optical internal urethrotomy (OIU) in patients with anterior and posterior urethral strictures at outpatient clinic. Methods: One hundred and twenty eight patients were prospectively randomized to perform OIU with intraurethral prilocaine solution (group 1 = 64 patients) or intraurethral lidocaine gel (group 2 = 64 patients). Visual analog scale was used for procedure related pain evaluation at the beginning, during, and one hour after the procedure. All patients had follow-ups for a minimum of 12 months. Treatment failure was defined as Qmax < 12ml/sec at uroflowmetry and observed urethral stricture on cystoscopy. Results: The overall success rate of the OIU was 75.8%. The intraoperative mean visual analogue score in group 2 (5,1 ± 1,77) was significantly higher than the group 1 (3.7 ± 1.9) (P = 0.0001). The median time to stricture recurrence was 9.2 months (range 1-13 months). Stricture recurrences were noted in 15 patients in Group 1 and 16 patients in Group 2 during the follow-up period. Conclusion: Prilocaine solution as a local anesthetic is a better option than intraurethral lidocaine gel in the OIU procedure and allows successful OIU to be performed in outpatient clinic. It can be preferred as a local anesthetic for OIU, particularly in unfit patients for general/regional anesthesia. Although it provides successful pain relief, it still cannot prevent experiencing moderate or severe pain in a group of patients. More studies about more effective local anesthetics for pain relief during OIU at the outpatient clinic are required.