Local anaesthetic flexible ureterorenoscopy: painful for all involved?
BAUS ePoster online library. Kadhim H.
Jun 26, 2018; 211312
Dr. Hassan Kadhim
Dr. Hassan Kadhim
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Introduction: Patients unfit for general anaesthesia who present with renal tract pathology currently have limited options. 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.

Patients and Methods: A single centre, retrospective analysis of 59 consecutive patients was performed over a 3-year period. Surrogate markers of success were (1) tolerability (2) success of procedure without complications (3) stone free rate after first procedure.

Results: 55% of patients were male. Mean age was 71 years and mean Charlson comorbidity Index was 6.3. 40% of patients were anticoagulated. 64% of ureteroscopies were for calculi, with a mean stone size of 6.5mm (range 1-20mm), with the majority ureteric (64%). All patients were able to tolerate the procedure. Flexible ureterorenoscopy (fURS) was successful without complication in 93% of patients. There were no complications above Clavien Grade 2. The stone free rate was 78%.

Conclusions: Flexible ureterorenoscopy under local anaesthetic provides a safe and effective method to investigate and treat renal tract pathology. This approach is a useful addition to the armamentarium available to patients deemed unsuitable for general anaesthesia.
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