AUA 2024: Office-Based Endoscopic Urological Procedures Under Local Anesthesia: Prospective Evaluation of Feasibility, Pain, and Patient Preference

( Dr. Anna Ricapito succinctly presented an assessment of the patient's pain and preference level as well as the feasibility of undergoing an in-office endourological procedure with topical anesthesia. These procedures can be done in various settings ranging from the hospital to the office; however, favorability for in-office procedures have risen as the office setting confers the benefits of lowered costs as well as efficiency. On the other hand, questions have been raised in regards to procedure outcomes and patient comfort which Dr. Ricapito and her team aimed to address.

In this prospective study, Dr. Ricapito included patients who were undergoing any of the following in-office endourological procedures between September 2022 and July 2023: 

  • Ureteral stent placement or exchange
  • Laser lithotripsy with ureteroscopy
  • Tumor ablation with ureteroscopy
  • Bladder stone lithotripsy
  • Bladder tumor laser ablation
  • Nephrostomy tube exchange
  • Ureteral catheterization

A total of 80 endourological procedures were included. Patient age, sex, Charles Comorbidity Index, post-procedure setting preference, costs, complications, and post-procedure pain score based on the visual analog score (VAS) were collected and evaluated.

The mean VAS scores of the bladder, ureteroscopic, and stent/nephrostomy procedures were 2.4, 3.9, and 3.3, respectively, indicating that pain experienced by patients were low.patient characteristics mean VAS scores of the bladder, ureteroscopic, and stent/nephrostomy procedures
Many patients preferred the office setting in which 100% of the patients underwent bladder or stent/nephrostomy procedures and 77.8% of the patients who underwent ureteroscopic procedures preferred office-based procedures. Office-based endourological procedures were safe with very few post-procedure calls (10%), ED visits (2.5%), complications (1.25%), and procedure failures (1.25%). In comparing office-based procedures to operating room-based procedures, office-based procedures were found to save anywhere from $5309 to $6009, a great reduction in procedure costs. 

Dr. Ricapito closed her presentation by concluding that these findings reinforce the feasibility and safety of office-based endourological procedures using topical anesthesia.

Afterward, Dr. Ricapito answered questions from the audience. One commentator asked if these office-based endourological procedures stopped in July 2023 to which Dr. Ricapito addressed with a statement that these office-based procedures are ongoing and data collection stopped in July 2023 because there was already sufficient data. Another commentator raised concerns about bladder perforation due to a mobile patient to which Dr. Ricapito answered that patients were given local lidocaine and were in a relaxed state. At the end, Dr. Ralph Clayman commended Dr. Ricapito’s work and stated that office-based endourological procedures are the future.

Presented by: Anna Ricapito, PGY3, M.D., University of Foggia, Italy, Department of Urology, Foggia, Italy

Written by: Victor Pham, B.S., University of California Irvine, @victorpham01 on X during the 2024 American Urological Association (AUA) Annual Meeting, May 3 – May 6, 2024, San Antonio, Texas