Outcome of Ureteroscopic Lithotripsy (URSL) under Local Anesthesia (LA) as a Day Care Procedure in Patients: An Experience in Regional Institute of Medical Sciences

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.