Ureteroscopy for Ureterolithiasis
with Sedation Only

Zisman, Amnon; Siegel, Yoram I.; Lindner, Arie

doi:10.1159/000475148

Cited by 16 publications

(5 citation statements)

References 6 publications

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“…There are many studies in the literature that compared the anesthesia methods used in URS (10,11,12,13,14,15,16). However, most of these studies compared local anesthesia with SA and GA.…”

Section: Discussionmentioning

confidence: 99%

Effect of the Anesthetic Method on the Outcomes of Ureteroscopy for Proximal Ureteral Stones: A Multi-center Study of the Society of Urological Surgery Aegean Study Group

Kızılay¹,

İrer²,

Şen³

et al. 2018

jus

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What's known on the subject? and What does the study add? Objective: To analyze the effect of the anesthesia method (spinal and general) on the outcome of ureteroscopy (URS) in patients treated for proximal ureteral stones. Materials and Methods: Patients, who underwent URS for proximal ureteral stones at various urology clinics in Turkiye, were included in the study. The patients were divided into two groups according to the anesthesia method performed; the procedure was performed under spinal anesthesia (SA) in group 1 and general anesthesia (GA) in group 2. Patients' demographic, perioperative data and complication rates were compared between the two groups in a retrospective manner. Results: There were 309 and 329 patients in groups 1 and 2, respectively. The mean stone area and Hounsfield unit in GA group were higher (p<0.001 and p=0.007, respectively). In the GA group, the need for double J stent was more frequent (p<0.001). In the SA group, the rate of push-back of stone into the collecting system was higher (p=0.017). According to the Clavien classification system and the others, complication rates were similar between the two groups (p>0.05). The rate of success of URS, which is accepted as complete stone-free status, was higher in the SA group (p=0.041). Conclusion: URS, which is used in the treatment of proximal ureteral stones, has a high success rate, independent of the anesthesia method used. It is important to keep in mind the patient's comorbidities prior to selecting the anesthesia method and that the stone area and the Hounsfield unit are the important factors affecting the outcomes.

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“…There are many studies in the literature that compared the anesthesia methods used in URS (10,11,12,13,14,15,16). However, most of these studies compared local anesthesia with SA and GA.…”

Section: Discussionmentioning

confidence: 99%

Effect of the Anesthetic Method on the Outcomes of Ureteroscopy for Proximal Ureteral Stones: A Multi-center Study of the Society of Urological Surgery Aegean Study Group

Kızılay¹,

İrer²,

Şen³

et al. 2018

jus

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“…The most important reasons for this belief are that the path to be undertaken in the ureter using the semirigid ureterorenoscope is longer, and the tense and physiologic cresses of the ureter disappear via the entire ureter, and the ureter becomes straight. Apart from these, urologists do not prefer regional anesthesia because it is not always successful, it causes anxiety in the patient, and adequate muscle relaxation is not achieved [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is necessary to change the anesthesia type. There are numerous studies comparing the anesthesia types performed before sURS; however, most studies compare local anesthesia with GA or SA [ 9 – 13 ]. Frequently, carefully selected patients, such as those with distal ureteral stones and female patients were included in these studies, and thinner caliber ureteroscopes are used during the surgeries.…”

Section: Discussionmentioning

confidence: 99%

Is spinal anesthesia an alternative and feasible method for proximal ureteral stone treatment?

Topaktaş

Altin

Aydın

et al. 2020

Cent european J Urol

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Introduction We investigated the clinical, operational, and pain parameters of patients who underwent semirigid ureterorenoscopy (sURS) under spinal anesthesia (SA) and general anesthesia (GA) for proximal ureter stones. Material and methods Patients treated with sURS after diagnosis of proximal ureter stones between January 2014 and May 2017 were reviewed retrospectively. The patients were divided into two groups (the SA group and the GA group) based on the type of anesthesia used. Perioperative variables and operation results were evaluated and compared. Success was defined as the patient being stone-free as observed on low-dose non-contrast computed tomography performed in the first month postoperatively. Results The SA and GA groups had 40 and 32 patients, respectively. There were no statistically significant differences between the groups in terms of age (p = 0.593), gender (p = 0.910), average stone size (p = 0.056), side (p = 0.958), or density (p = 0.337). Based on the Clavien classification system, complication rates between the two groups were similar. The postoperative visual pain scale in the SA group was statistically significantly lower (p <0.05) than in the GA group. Success rates in the SA and GA groups were found to be 90% (36/40) and 93.7% (30/32), respectively, with no significant difference between the groups (p = 0.819). Conclusions Ureterorenoscopy, which is performed for proximal ureter stone treatment in adult patients, is a reliable surgical method that can be performed under both SA and GA. SA offers the advantage of reduced postoperative pain as compared to GA.

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“…Während sich dies in zahlreichen ausländischen Veröffentlichungen widerspiegelt, in denen die URS als ambulanter Eingriff, in Analgosedierung, in Lokalanästhesie, für Kelchsteine, bei multimorbiden adipösen Patienten, bei Kindern und selbst in der Schwangerschaft untersucht wurde [4,5,6,7,8,22,26,38,39,40], hat die deutsche Gesetzgebung bis zur Einführung der DRGs durch die Finanzierung über die Liegedauer solche Entwicklungen nicht in gleichem Maße gefördert. Deshalb ist es nicht verwunderlich, dass es zur URS in Analgosedierung nur wenige deutsche Veröffentlichungen gibt.…”

Section: Ureterorenoskopieunclassified

“…Konversionen zur ITN-Narkose waren noch in 17,4% erforderlich. Er konnte jedoch bereits die fehlende Kompromittierung von Erfolgsund Komplikationsrate feststellen, wäh-rend Zisman 1995 [40] in einer kleinen Serie mit 28 Sedoanalgesie-Ureterorenoskopien noch eine Reduktion der Steinfreiheitsrate von 72% auf 42% hinnehmen musste.…”

Section: Abb 6 ▲ Vergleich Der Schmerzangaben Von Männern Und Frauenunclassified

Die Ureterorenoskopie in Analgosedierung

2004

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In a prospective study, from September 2000 to September 2001, all ureteroscopies ( n=140) were performed under local and intravenous patient controlled analgesia using continuous infusion of remifentanil (Ultiva). The dosage of 0.15 micro g/kg/min was adapted to changing intraoperative pain (range 0.08-0.30 micro g/kg/min). Preoperative sedation with midazolam 2 mg was given 5 min prior to ureteroscopy. The efficacy of monitored anesthesia care ("Big MAC") was quantified by the patient using a visual analogue pain scale. A total of 97.1% (136/140) of the procedures were performed and finished under remifentanil. Only four male patients underwent conversion to general anesthesia due to insufficient analgesia. All but one patient would choose remifentanil again for first line anesthesia. Significant differences in pain scale values were noticed for male/female patients and ureteroscopies above/below the iliac vessel crossing. Side effects were rare being mainly hypoxic events (pO(2)<90% in 5.1%). Indication, intraoperative procedure, average surgery time (24 min), complications and primary success rate (96.6/90/63.3% stone free for distal/mid/proximal ureter, respectively) did not differ from the control group under general anesthesia. Ureteroscopies with remifentanil are safe, universally applicable because of refifentanil's organ independent esterase metabolism and as effective as general anesthesia. There is no need for PACU stay for patients due to the ultra-short drug half-life, and therefore remifentanil is cost effective and perfect in an outpatient setting.

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Ureteroscopy for Ureterolithiasis with Sedation Only

Cited by 16 publications

References 6 publications

Effect of the Anesthetic Method on the Outcomes of Ureteroscopy for Proximal Ureteral Stones: A Multi-center Study of the Society of Urological Surgery Aegean Study Group

Effect of the Anesthetic Method on the Outcomes of Ureteroscopy for Proximal Ureteral Stones: A Multi-center Study of the Society of Urological Surgery Aegean Study Group

Is spinal anesthesia an alternative and feasible method for proximal ureteral stone treatment?

Die Ureterorenoskopie in Analgosedierung

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