Local Anesthetic Flexible Ureterorenoscopy in the Management of Urolithiasis

Pai, Aakash; Kadhim, Hassan; Mackie, Simon; Watson, Graham

doi:10.1089/end.2019.0107

Cited by 6 publications

(12 citation statements)

References 17 publications

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“…Herein, we have shown that our approach is safe and effective in managing upper tract pathology for appropriately selected patients-with greater success in those receiving higher doses of midazolam and those who are being assessed for UTUC or obstruction. Furthermore, our success rate and complication rates were similar to those reported with GA, [4][5] and local or loco-sedative anesthesa [9][10][11][12][13][14][15][16][17][18][19] (with success rates ranging between 78-100% and complication rates ranging between 1-11%). This comparison provides external validity to our findings and indicates that in carefully selected patients, URS under loco-sedative anesthesia is likely noninferior to that with GA.…”

Section: Discussionsupporting

confidence: 84%

“…One study used only intraurethral lidocaine to treat upper urinary tract calculi with a median size of 8 mm. 17 Their overall stone-free rate was 84%, with a 91.5% stone-free rate in the mid and distal ureter. A second study used total intra-ureteric topical anesthesia for treatment of a single ureteric calculus less than 1 cm (excluding intra-renal calculi).…”

confidence: 92%

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Ureteroscopy under conscious sedation: A proof-of-concept study

Jain

Blachman‐Braun²,

Jain³

et al. 2022

CUAJ

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Introduction: Ureteroscopies (URSs) are commonly performed under general anesthesia (GA) to maximize patient tolerability and minimize surgical complications. However, given the improvements in endoscopic technology and risks associated with GA, alternate forms of anesthesia have been postulated. We aimed to evaluate the outcomes of URS under conscious sedation. Methods: We completed a retrospective cohort study from November 2019 to June 2020 at a tertiary-level hospital. All URSs that were performed under urologist-directed conscious sedation were included. Our primary outcome was the ability to complete URSs, defined as success rate. Secondary outcomes included: stone-free rate, intraoperative complication rate, hospital admission rate, and sedation requirement. Univariate- and multivariate-adjusted logistic regression analyses were employed. Results: Ninety-nine URSs were included. Most (73/99, 73.7%) were performed for urolithiasis. The overall success rate was 83.8% (83/99), with 81.0% (34/42) intra-renal and 70.0% (16/23) proximal ureter success rates. The stone-free rate was 80.8% (59/73). No intraoperative complications nor hospital admissions were reported. The mean amount of sedation required was three (interquartile range [IQR] 2–4] mg of midazolam and 100 (100–150) μg of fentanyl. On multivariate analysis, midazolam was significantly associated with increased success (odds ratio 2.496, 95% confidence interval 1.057–5.892, p=0.037). Conclusions: We have shown that proximal and intra-renal URS under conscious sedation is safe and effective. We were limited by our lack of followup, small sample size, selection bias to chose healthy patients, and lack of patient tolerability data. Patients and healthcare systems may benefit from implementing this innovation more broadly.

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Section: Discussionsupporting

confidence: 84%

confidence: 92%

Ureteroscopy under conscious sedation: A proof-of-concept study

Jain

Blachman‐Braun²,

Jain³

et al. 2022

CUAJ

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“…Most of the complications associated with retrograde flexible ureteroscopic approach are mild. In study of flexible ureteroscopy under local anesthetic, Pai et al didn't encounter any complications above Clavien II (5).…”

Section: Discussionmentioning

confidence: 98%

Morbidity of Retrograde Flexible Ureteral Approach for Pyelo-Caliceal Stones - A Retrospective Review of 4500 Procedures

Geavlete¹,

Multescu²,

Geavlete³

2020

chr

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Introducere: Abordul ureteroscopic flexibil retrograd este o procedură eficientă şi relativ sigură. Scopul studiului a fost evaluarea retrospectivă pe un număr semnificativ de cazuri a siguranţei abordului ureteroscopic flexibil retrograd la pacienţii cu litiază pielo-caliceală. Material şi Metodă: Am evaluat retrospectiv 4500 ureteroscopii flexibile retrograde efectuate în două centre medicale. Complicaţiile asociate acestui tip de abord au fost identificate retrospective şi stratificate conform clasificării Clavien-Dindo. Rezultate: Incidentele intraoperatorii au fost identificate în 5,2% din proceduri. Complicaţiile au survenit în 18,9% din proceduri. Două treimi au fost complicaţii septic, teaca de acces ureteral dovedindu-se un factor de protecţie împotriva acestora. Majoritatea complicaţiilor au fost uşoare. În 4,8% din cazurile în care a fost utilizată teaca de acces ureteral au survenit leziuni de perete ureteral gradul 2 şi 3. Concluzii: Majoritatea complicaţiilor associate abordului ureteroscopic flexibil retrograd sunt uşoare, indiferent de tipul ureteroscopului utilizat. Presiunea redusă la nivelul sistemului pielocaliceal este importantă pentru menţinerea ratei complicaţiilor (atât septice cât şi non-septice) cât mai mică. Cuvinte cheie: complicaţii, ureteroscopie flexibilă, septic, teacă de acces ureteral

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“…However, there are very limited studies on the use of holmium laser under local anesthesia in stone disease [ 23 ]. Pai et al [ 24 ] evaluated the use of holmium laser in ureter stones under local anesthesia. They discussed 85 cases and reported the success rate as 82%.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Holmium Laser Lithotripsy Under Local Anesthesia in the Treatment of Urethral Stones in Elderly Male Patients

Atılgan

Kölükçü

Fırat³

et al. 2020

Healthcare

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The elderly population has been increasing significantly in our century. In our study, it was aimed to analyze the treatment results of elderly male patients who underwent holmium laser lithotripsy (HLL) for urethral stones under local anesthesia. We evaluated a total of 31 male patients, aged ≥65 years, diagnosed with urethral stones and treated with HLL under local anesthesia. We noted the demographic data and visual pain scores (VAS) of the patients and the duration of the operation and hospital stay. Our analysis involved both the success rates of the surgical procedure and the complication rates according to the modified Clavien classification. In addition. we determined the patients’ preoperative clinical status using the Charlson comorbidity index (CCI). The mean age of the patients was 71.65 ± 8.19 years. Acute urinary retention was the most common complaint (45.2%). Their mean scores were 7.68 ± 2.53 according to CCI. The average operation time was 15.48 ± 5.22 min and the VAS was 2.03 ± 1.08. All patients were stone-free and there was a marked improvement in their symptoms None of them stayed in the hospital for more than one day. We did not observe any Grade 3 or higher complications. In light of the data obtained in our study, we concluded that HLL is an effective and reliable method to treat urethral stones under local anesthesia in elderly male patients.

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Local Anesthetic Flexible Ureterorenoscopy in the Management of Urolithiasis

Cited by 6 publications

References 17 publications

Ureteroscopy under conscious sedation: A proof-of-concept study

Ureteroscopy under conscious sedation: A proof-of-concept study

Morbidity of Retrograde Flexible Ureteral Approach for Pyelo-Caliceal Stones - A Retrospective Review of 4500 Procedures

Efficacy and Safety of Holmium Laser Lithotripsy Under Local Anesthesia in the Treatment of Urethral Stones in Elderly Male Patients

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