Ureteroscopic Lithotripsy under Local Anesthesia: Analysis of the Effectiveness and Tolerability / 대한비뇨기과학회지

PURPOSE: This study attempted to evaluate the feasibility and effectiveness of ureteroscopic lithotripsy under local anesthesia. MATERIALS AND METHODS: Two hundred patients(male 91; female 109) underwent ureteroscopic lithotripsy under local anesthesia; and the results evaluated. Pain perception during the local ureteroscopic procedure was compared with that of cystoscopy, using a visual analogue pain scale(semantic differential) recorded by the patient(0-no pain; 10-maximal pain). RESULTS: The overall success rate was 93%(185/200). The success rates of upper, mid and lower ureteral stones were 83(5/6), 78(14/18) and 94%(166/176), respectively. The success rates in stones less than 10mm and more than 10mm were 94 (166/176) and 86%(30/35), respectively. There were 5 cases(3%) of complications: ureteral injury(1), pyelonephritis(2) and ureteral stricture(2). Although the mean pain scale score was higher in the ureteroscopy(3.33+/-1.75) than the cystoscopy group (3.13+/-1.92), this was not statistically significant(p>0.05). Most of the patients tolerated the pain during the procedure, with only two requiring general anesthesia. The postoperative pain was also tolerable in most patients, with only 8(4%) requiring more analgesics after the procedure. CONCLUSIONS: The effectiveness and morbidity of ureteroscopic lithotripsy, under local anesthesia, was found to be comparable with many other previous reports, and most of the patients could tolerate the pain of the procedure. Therefore, ureteroscopic lithotripsy can be performed effectively and safely under local anesthesia.

The Value of Cystoscopy as an Initial Diagnostic Modality for Asymptomatic Microscopic Hematuria

For the patients who visit outpatient clinics due to asymptomatic microscopic hematuria, cystoscopy has been looked upon as rather invasive compared to other diagnostic methods. We tried to elucidate the actual diagnostic value of cystoscopy in the initial evaluation of asymptomatic microscopic hematuria. We reviewed the results of cystoscopic examinations in 213 patients who visited our hospital due to asymptomatic microscopic hematuria. No definite lesion that could explain the microscopic hematuria was detected by means of IVP, urine cytology, and other nephrologic evaluations for all the patients. Among the abnormal cystoscopic findings in 55 patients, the lesions suspected to be directly related to microscopic hematuria were classified as 'significant lesions' (31 patients, 17.6%) which include entities such as bladder cancer (1.31%). 27 of 31 patients with significant lesions (85.2%) were over 50 yr old, and furthermore, 3 patients who were diagnosed as bladder tumor by cystoscopy were over 60 yr. Cystoscopy should be utilized as initial diagnostic modality in lder patients with asymptomatic microscopic hematuria to rule out any possibility of bladder cancer occurrence. Further studies are needed to justify implementation of cystoscopy as an initial diagnostic modality in younger patients with asymptomatic microscopic hematuria.