Introduction Patients unfit for general anaesthesia who present with renal tract pathology currently have limited options. Many of these patients present in the emergency setting with imperative reasons for intervention including sepsis, renal failure and pain. Conservative management and temporising measures, such as percutaneous nephrostomy, are associated with significant morbidity. Ureterorenoscopy (URS) is a central component of the management of upper tract disease and is routinely performed under general anaesthesia. We describe our institution's experience of ureterorenoscopy using only local anaesthetic lubricating gel per urethra. Methods A single centre, retrospective analysis of 78 patients was performed over an 11 year period. Demographic data and Charlson Comorbidity Index scoring were collected for all patients. Outcomes including stone free rates, tolerability and complications were analysed. Results 58% of patients were male. Mean age was 68 and Charlson Comorbidity Index was 5.2. Indications for URS included pain (68%) and renal failure (15%). 10% of patients had previously had retrograde stenting due to sepsis. Median stone size was 8mm. All patients were able to tolerate the procedure and none were abandoned due to pain. The overall stone free rate was 82% after one procedure. The stone free rate for mid and distal ureteric stones was 97%. 19% of patients were left with a ureteric stent after the procedure, with the remaining patients left totally tubeless. Median length of stay was one day. There were no complications above Clavien Grade 2. Conclusion Urologists are increasingly faced with unfit patients presenting with urolithiasis. In the appropriately selected patient, local anaesthetic flexible ureterorensocopy is a feasible option with good outcomes. This approach is a useful addition to the armamentarium available to patients deemed unsuitable for general or regional anaesthesia.
Journal of endourology. 2019 May 07 [Epub ahead of print]
Aakash Pai, Hassan Kadhim, Simon Mackie, Graham Watson
Eastbourne District General Hospital, 156664, Eastbourne, East Sussex, United Kingdom of Great Britain and Northern Ireland ; ., Eastbourne District General Hospital, 156664, Eastbourne, East Sussex, United Kingdom of Great Britain and Northern Ireland ; ., Eastbourne District General Hospital, 156664, Eastbourne, East Sussex, United Kingdom of Great Britain and Northern Ireland ; ., Eastbourne District General Hospital, 156664, Eastbourne, East Sussex, United Kingdom of Great Britain and Northern Ireland ; .