Introduction: Improvement in technology for endoscopic instrumentation and lithotripsy devices has allowed much advancement in ureteroscopic lithotripsy and has, to an extent, replaced open stone surgery. Ureteroscopic lithotripsy (URSL) is a more effective treatment of ureteric stones as compared to extracorporeal shock wave lithotripsy (ESWL) but has a downside as it requires spinal or general anaesthesia.
Patients and methods: In this record-based cohort study, we evaluated the outcome of URSL under local anaesthesia and intravenous analgesia in 150 patients with lower and mid ureteric calculus to establish its feasibility, safety, and tolerability.
Results: Association of various factors with overall outcome in terms of stone-free status and pain was analyzed in 149 patients. In patients with a stone of size < 10mm, calculus was completely fragmented and retrieved in 94.7%, while in patients with calculus of size >10mm, stone-free status was achieved in 82.2% ( statistically significant P value 0.016 ). The success rate of URSL for mid ureteric calculus was 86% whereas, for lower and VUJ calculus, it was 90.2%.
DJ stent placement before planned URSL was done in 81.3% of patients. We observed no statistically significant difference in achieving stone-free status with respect to laterality, location of calculus (P-value 0.427), and DJ stenting before URSL (P-value 0.430).
Laterality of calculus (left-sided) had a statistically significant effect on the severity of pain in our study(P-value 0.047). URSL under local anaesthesia and intravenous analgesia were acceptable to 70.5 % of patients, while 6% of patients opined it as a painful procedure. We have observed a statistically significant relationship of calculus size with achieving stone-free status (P-value 0.016).
Conclusions: Our findings suggest that URSL as a daycare procedure is feasible under local anaesthesia and intravenous analgesia, as a majority of patients tolerate the procedure and outcome in form of stone clearance is not compromised.
Key words: Ureteroscopic lithotripsy (URSL), DJ Stenting, Stone free status (SFS)
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