Presented by: Kunal Jain MD
University of Manitoba, Section of Urology

Introduction

The standard of care is to perform ureteroscopy under spinal or general anesthesia; however, it has been demonstrated that ureteroscopy can be safely performed under conscious sedation. Literature has lacked is in comparing patient-reported and surgical outcomes for ureteroscopy under sedation versus spinal/general anesthesia. We aimed to address this knowledge gap.

Materials

All ureteroscopies from June to December 2023 performed at the provincial stone-centre, tertiary-care hospital will be approached for enrollment. Patient-specific, procedure-specific, and peri-operative variables will be collected. A validated questionnaire to assess patients’ pain and tolerability will be distributed to nurses and surgeons on the day of the procedure and to patients one-week post-procedure. The primary outcome is patient tolerability of ureteroscopy with sedation versus spinal/general anesthesia. Secondary outcomes include stone-free rate, peri-operative complications, and predictors of opting for anesthetic type. Statistical analysis including univariable- and multivariable-adjusted logistic regression analyses will be performed.

Results

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5 ureteroscopies have occurred, all under sedation. 4/5 (80%) were in males. Ages ranged from 18-72. All had Charlson comorbidity index values 3 or less. Stones ranged from 2 to 8mm in size. 2/5 (60%) were intrapolar and 1/5 (20%) each were in the upper, mid, and distal ureter. All ureteroscopies were successfully completed under sedation with surgeon perceived stone burden as either no remaining stones or stone fragments small enough to pass. Mean operative, anesthetic, and recovery times were 20 (6-45), 5 (3-10), and 36 (30-45) minutes, respectively. No patients required additional analgesics, anti-emetics, or admission. Surgeon perceived patient tolerability ranged from 1-4/10 whereas nurse perceived patient tolerability ranged from 1-7/10 on the visual analogue scale. Of the 3/5 (60%) patients who responded, 2/3 (66%) reported an uncomplicated experience. 1/3 (33%) felt pain with a mild headache that resolved within 4 hours after the surgery. Pain 2 hours after surgery was reported as a maximum of 2/10. All would choose sedation in the future.

Conclusion

Preliminary data shows that ureteroscopy under sedation is well tolerated. We hope to show that patient-reported and surgical outcomes of ureteroscopy under sedation are comparable, if not better, than those under spinal/general anesthesia, without placing those choosing sedation at additional risk.

Funding

None.

Co-Authors

Brian Peters, MD, FRCSC
University of Manitoba, Section of Urology

Premal Patel, MD, FRCSC
University of Manitoba, Section of Urology

Gregory Hosier, MD, FRCSC
University of Manitoba, Section of Urology