Presentation Authors: Ali Tasleem*, Southend, United Kingdom, Sachin Yallappa, Glasgow, United Kingdom, Michael Mikhail, Southend, United Kingdom, Tarik Amer, Glasgow, United Kingdom, Peter Acher, Peter Pietrzak, Antony Young, Southend, United Kingdom
Introduction: Patients are living longer with an increasing number of co-morbidities. Minimally invasive ureterorenoscopy (URS) to manage calculi or transitional cell carcinoma can be performed on a day-case basis under general or spinal anaesthesia, however certain co-morbid patients are not suitable for this and require a different approach. We report on URS under local anaesthesia (LA) using intra-ureteric bupivacaine as the primary form of anaesthesia
Methods: A retrospective analysis over 6 years at a single centre was undertaken on all patients who underwent URS under LA. Patients were placed in the lithotomy position and prepared and draped as for cystoscopy. Intra-urethral 2% lidocaine gel was instilled prior to cystoscopy. A guidewire followed by a dual lumen catheter were inserted into the ureter and bupivicaine 0.5% was infused under pressure. After 2 minutes, an access sheath was inserted and URS performed with stone fragmentation using a Holmium: YAG laser. Procedural time was generally limited to one hour as the surgeon's preference for ureteroscopy.
Results: Twelve patients had a total of 42 procedures under LA. Stone size varied from 4-35mm. Seventy-one percent of procedures (30/42) did not require any sedation or intravenous analgesia as an adjunct to the bupivacaine. No procedures were abandoned and there were no conversions to general/spinal anaesthesia. Eighty-one percent of cases (34/42) were performed as day-case or overnight stays. There were no complications secondary to the use of LA and the complication rate overall was similar to that for conventional anaesthesia.
Conclusions: This study highlights that URS can be safely performed under LA. It is well tolerated and represents an option for a carefully selected cohort patients who have been adequately counselled, and who would be at high risk from conventional anaesthesia due to cardiovascular or respiratory co-morbidities. Such patients may otherwise be considered &[Prime]unfit&[Prime] for endourological intervention under conventional anaesthesia.