Background: Ureteroscopic lithotripsy (URSL) has been usually performed under general anesthesia or spinal anesthesia. URSL under local anesthesia (henceforth, local URSL) is not usually performed, largely due to a fear of the risk of ureteral injury caused by painful jerky movement by the patient or of the patient complaining of pain during the procedure.
Aim: We report early results of URSL under local anesthesia
(LA) as a day care procedure in Department of Urology, Regional Institute of
Medical Sciences (RIMS) hospital on aspects of per operative pain, completion
of procedure, stone clearance, hospital stay, complications and patient
compliance.
Materials and Methods: Patients with lower ureteric calculus
attending urology outpatient department, Regional Institute of Medical Sciences
(RIMS) Hospital during August 2011 to February 2012 underwent URSL under
LA-analgesia as day care procedure. The results are analyzed on aspects of
perioperative pain, completion of procedure, stone clearance, hospital stay,
complications and patient compliance. Institutional ethical clearance and
written informed consent for the procedure taken from all patients for the
study.
Results: A total of 30 patients with lower ureteric calculus
size ranging from 8 to 15 mm underwent URSL with Double J stenting under local
anesthesia in RIMS urology operation theatre. Twenty-four patients completed
the procedure in single session, five required two sessions (four with ureteric
stricture DJ stent kept for passive dilation and one patient had edematous non
visualized ureteric orifice) and another patient converted to open
ureterolithotomy due to hard stone resistant to our pneumatic energy. None of
the patients required hospital stay following the procedure except for two
patients for IV antibiotics. The visual analog scale was mild in 15 patients,
moderate in 10 and severe in five patients. Dysuria with transient hematuria
was the most common complication; all were managed conservatively on OPD basis.
Overall patient compliance for this procedure was excellent. The infrastructure of service and staffing
required is also major limitations. Furthermore, the physician or the patient
may be reluctant to undertake the procedure on an out-patient basis. This study
was formulated to highlight the success of local URSL in the treatment of mid
and lower ureteric stones.
Conclusion: Given the
extreme discomfort the patient is experiencing, ureteric colic is considered a
urological emergency. The idea of URSL as a day care procedure began in our
department due to the lengthy wait times for routine OT, the concern of
obstructive uropathy with urosepsis and the ensuing decline in renal function,
and the positive early results of this procedure in carefully chosen patients.
Author(s) Details:
Somarendra Khumukcham,
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
Sandeep Gupta,
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
Bijit Lodh,
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
Sholay Meitei Kangjam,
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
Kaku Singh Akoijam,
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
Rajendra Singh Sinam,
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
Please see the link here: https://stm.bookpi.org/NVMMS-V3/article/view/13952
