Ureteroscopy under conscious sedation: A proof-of-concept study |
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| Authors: | Kunal Jain Ruben Blachman-Braun Esha Jain Amanda Eng Brian Peters Premal Patel |
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| Affiliation: | 1.Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada; 2.Department of Urology, University of Miami, Miami FL, United States |
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| Abstract: | IntroductionUreteroscopy (URS) is commonly performed under general anesthesia (GA) to maximize patient tolerability and minimize surgical complications; however, given the improvements in endoscopic technology and risks associated with GA, alternate forms of anesthesia have been postulated. We aimed to evaluate the outcomes of URS under conscious sedation.MethodsWe completed a retrospective cohort study from November 2019 to June 2020 at a tertiary-level hospital. All URSs that were performed under urologist-directed conscious sedation were included. Our primary outcome was the ability to complete URS, defined as success rate. Secondary outcomes included: stone-free rate, intraoperative complication rate, hospital admission rate, and sedation requirement. Univariate- and multivariate-adjusted logistic regression analyses were employed.ResultsNinety-nine URSs were included. Most (73/99, 73.7%) were performed for urolithiasis. The overall success rate was 83.8% (83/99), with 81.0% (34/42) intra-renal and 70.0% (16/23) proximal ureter success rates. The stone-free rate was 80.8% (59/73). No intraoperative complications nor hospital admissions were reported. The mean amount of sedation required was 3 mg (interquartile range [IQR] 2–4] of midazolam and 100 μg (100–150) of fentanyl. On multivariate analysis, midazolam was significantly associated with increased success (odds ratio 2.496, 95% confidence interval 1.057–5.892, p=0.037).ConclusionsWe have shown that proximal and intrarenal URS under conscious sedation is safe and effective. We were limited by our lack of followup, small sample size, selection bias to chose healthy patients, and lack of patient tolerability data. Patients and healthcare systems may benefit from implementing this innovation more broadly.KEY MESSAGES- We demonstrated the ability to effectively perform diagnostic and therapeutic ureteroscopy under urologist- directed conscious sedation, especially in the proximal ureter and renal pelvis. This approach may expedite patient care without compromising safety.
- This study is of extra importance during the restraints on our healthcare system during the COVID-19 pandemic.
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