ABSTRACT
Objective: We evaluated the feasibility and effectiveness of ureteroscopic lithotripsy for ureteral stones under local anesthesia without any sedation.
Methods: Prospectively, ureteroscopic lithotripsy under local anesthesia was performed in 100 patients (45 males and 55 females). A rigid endoscope (8.5 to 11.5 Fr) was used in all cases. Local anesthesia consists of lidocaine jelly in the bladder associated with a penile nerve block in males only, and without any intravenous analgesia. Ureteroscopy was done for stone fragmentation with a double-J catheter insertion in 13 patients. We compared the pain perception during ureteroscopy to that of cystoscopy performed during the same procedure, using a visual-analogue pain scale recorded by the patient.
Results: The overall success rate was 82%. The success rates of the upper, mid, and lower ureteral calculi were 71.4%, 72.7%, and 89%, respectively. The success rate was 100% in calculi less than 10 mm, and 80.3% in those more than 10 mm. Postoperatively, 1 patient developed pyelonephritis. We didn’t report any cases of ureteral perforation. The mean pain scale score was lower during the ureteroscopy (3.61 [2.2 to 8.5]) than in cystoscopy (4.52 [1.5 to 8] [p <0.001]). Almost all patients tolerated pain well during the procedure. The procedure was interrupted in only 5 patients and was performed later under spinal anesthesia. Postoperative pain was also tolerable in most patients, and only 8 patients required additional analgesics after the procedure.
Conclusion: Our findings suggest that most of the patients could tolerate the pain during a rigid ureteroscopic lithotripsy under local anesthesia. This procedure does not increase the risk of complications or compromises the results of treatment. Thus, it may be recommended in carefully selected and informed patients and performed with experienced hands.
KEYWORDS: Ureteroscopy; Local anesthesia; Stone; Lithotripsy; Pain
CORRESPONDENCE: Satâa Sallami, Department of Urology, La Rabta Hospital, University of Tunis, El Manar, Tunis, Tunisia (sataa_sallami@yahoo.fr).
CITATION: UroToday Int J. 2011 Dec;4(6):art 77. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.10
