Presented by: Kashif Visram MD
Division of Urology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada

Introduction

Ureteral stents are utilized for various indications, such as obstructing stones, ureteral strictures, and ureteropelvic junction obstructions. Insertion of ureteral stents are typically done with the patient under general anesthesia (GA) which requires substantial OR resources. Stent insertion under local anesthesia (LA) has been described in the literature, but uncommonly used. At our hospital this has been a standard practice for many years (St. Michael’s Hospital, Toronto). Our aim is to describe our experience of ureteral stent placement under LA and demonstrate its safety and efficacy. 

Materials

In this retrospective observational study, patients who underwent ureteral stent insertion under LA for any indication at our centre between 2017 and 2022 under a single surgeon were identified. All patients were provided transurethral xylocaine jelly only (with no conscious sedation or general anaesthesia), and flexible cystoscopes were used along with c-arm fluoroscopy for insertion or exchange of ureteral stent(s) in the cystoscopy unit. Patient demographics, indication for stent, size and location of stone (if applicable), success, reason for failure, requirement for admission, patient tolerance and complications, were analyzed.

Results

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A total of 53 patients were identified to have undergone ureteral stent insertion or exchange under LA. With regards to indication, 36 (68%) patients had obstructing ureteral stones, 7 (13%) patients had ureteropelvic junction obstruction, and 6 (11%) patients had ureteric strictures. Forty-eight (90.5%) patients had successful outcomes; of which 44 (83%) patients had successful unilateral stent insertions, 4 (7.5%) patients had successful bilateral stent insertions, and 4 (7.5%) had successful unilateral stent exchanges. There were 4 (7.5%) failed stent attempts identified. Two of these failed attempts were due to patient intolerance. Two patients reported discomfort under LA despite successful outcomes. No patient was admitted for post-procedural or stent related pain.

Conclusion

Insertion of ureteric stents under LA is effective and efficient, especially for obstructing ureteral stones, and is well tolerated by patients. With correct patient selection, this may be a useful approach and may decrease OR time and use of OR/anesthesia resources. Limitations of our study include the retrospective nature of our data, the lack of a GA arm for comparison, and single surgeon sample. Next steps include further analysis of the other urologists’ patients at our centre meeting the inclusion criteria.

Funding

The authors have no funding to declare. 

Co-Authors

Kashif Visram, MD, FRCSC
Division of Urology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada

Shamir Malik, BHSc
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Jason Y. Lee, MD, MHPE, FRCSC
Division of Urology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

Michael Ordon, MD, MSc, FRCSC
Division of Urology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada

Kenneth T. Pace, MD, MSc, FRCSC
Division of Urology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada

Robert J. Stewart, MD, FRCSC
Division of Urology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada

Monica Farcas, BEng, MEng, MD, FRCSC
Division of Urology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada