Department of Surgery, Section of Urology
University of Manitoba
Ureteroscopy with conscious sedation is safe and efficacious: A single-centre, prospective study
Kunal Jain1, Amanda Eng1, Ruben Blachman-Braun2, Esha M Jain3, Brian G. Peters1, Premal Patel1.
1Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada; 2Department of Urology, University of Miami, Miami, FL, United States; 3College of Medicine, American University of Antigua, St. John's, Antigua and Barbuda
Introduction: Ureteroscopy (URS) is a common, minimally invasive, surgical procedure for upper urinary tract conditions. While URS has been typically performed with general or spinal anesthesia, our centre has published on the feasibility of using conscious sedation for distal ureteric stones.1 Given the reduction of operating slates during the COVID-19 pandemic and the advent of smaller, semirigid and flexible ureteroscopes, we sought to study whether URS with conscious sedation is safe and effective.
Methods: From November 2019 to June 2020, we prospectively collected data from patients undergoing URS with local anesthetic and urologist-directed, nursing-administered intravenous sedation. Using SPSS, continuous and categorical variables were analyzed with Student T or Mann-Whitney U tests and Chi-squared or Fisher's exact test, respectively. Multivariate-adjusted logistic regression analysis was performed to assess associations with successful URSs.
Results: All 99 URSs were included: 73 for urolithiasis, 24 for upper tract urothelial carcinoma (UTUC), and 2 for obstruction. Mean age was 61.2 ± 13.7 years, with 55 males and 44 females. Mean sedation used was 3 mg (IQR: 2-4) of midazolam and 100 μg (IQR: 100-150) of fentanyl. Median fluoroscopy time was 56.5 seconds (IQR: 30.8-96.3). The overall success rate was 83.8% (83/99, Tables 1-3). URS for urolithiasis was associated with a lower success rate than those for UTUC or obstruction (OR: 0.157, 95% CI: 0.025-0.973, p=0.047). Increased use of midazolam was associated with a higher success rate (OR: 2.496, 95% CI: 1.057-5.892, p=0.037, Table 4).
Conclusions: This is the first study to demonstrate the safety and efficacy of URS with conscious sedation. Our findings must be understood within the limitations of a single-centre analysis. We plan to prospectively collect patient-reported outcomes to assess patient tolerability of URS with conscious sedation.
 Kroczak TJ, Kaler KS, Patel P, Al-Essawi T. Ureteroscopy with conscious sedation for distal ureteric calculi: 10-year experience. Can Urol Assoc J. 2016;10(1-2):E12-E16. doi:10.5489/cuaj.3302
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