Asunto(s)
Dolor Irruptivo/prevención & control , Cálculos Renales/cirugía , Nefrostomía Percutánea/efectos adversos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Acetaminofén/uso terapéutico , Adulto , Anciano , Procedimientos Quirúrgicos Ambulatorios , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Femenino , Humanos , Ibuprofeno/uso terapéutico , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Dimensión del Dolor , Dolor Postoperatorio/etiología , Músculos Paraespinales , Periodo Posoperatorio , Estudios Prospectivos , Vértebras TorácicasRESUMEN
Objectives: To investigate the feasibility and efficacy of live renal ultrasonography to guide Double-J ureteral stent placement at the bedside. Patients and Methods: Between April 12 and June 5, 2020, patients presenting with acute ureteral obstruction requiring decompression were prospectively selected for ultrasound-guided bedside ureteral stent placement. During stent placement, upper tract access confirmed using ultrasound with or without retrograde injection of ultrasound contrast before Double-J stent insertion. A postprocedural abdominal X-ray was obtained for stent position confirmation. Results: Eight patients (four men and four women) were offered bedside ultrasound-guided ureteral stent placement, and all eight consented to proceed. Stents were placed in seven of eight patients. One patient had an impacted ureterovesical junction stone and stricture requiring ureteroscopy and laser lithotripsy in the operating room. All patients tolerated procedures without immediate complications. Conclusion: Live renal ultrasonography can facilitate a high success rate for bedside ureteral stent placement outside the operating room. This approach is an attractive alternative to fluoroscopy-guided stent placement in the operating room and is of particular value in the COVID-19 era when judicious use of these resources is salient.