Ureteric stent insertion under local anaesthesia (LA): An effective, safe, and welltolerated alternative to general anaesthesia

ABSTRACT

Background: The placement of ureteric stents under local anaesthesia (LA) offers the potential for an effective and safe alternative to general anaesthesia in the context of an increasingly co-morbid population and the ongoing COVID-19 pandemic. Objectives: (1) To assess the outcomes for patients with acute ureteric stones managed with the insertion of an emergency ureteric stent under LA. (2) To report the key procedural and logistical elements required to undertake successful LA stent placement. Methods: Patients presenting with CT confirmed, obstructing ureteric stones between 17/04/2020 and 06/07/2021 were included where insertion of an LA ureteric stent was undertaken as an emergency. The primary outcome was procedure success rate and secondary outcomes were serious post-procedure complication rate (defined as Clavien-Dindo. 3), time from CT diagnosis to stent placement, and patient tolerability (defined as pain from the procedure measured on a numerical rating scale 0-10, and reported concern regarding undergoing the same procedure in the future with the options of no problem/minor problem/moderate problem/major problem). Results: Twenty-three patients underwent emergency LA ureteric stent placement for obstructing calculi with sepsis (73.9%, n = 17), uncontrolled pain (17.4%, n = 4) or acute kidney injury (8.7%, n = 2). The procedural success rate was 95.7% (n = 22/23), and the total number of serious complications was one (4.3%) (ureteric stent migration in duplex system). The median time from diagnosis to stent was 5.3 hours (interquartile range (IQR) = 16.3). The median pain score was 2 (IQR = 5.8), and most patients (73.9%, n = 17/23) reported they would have no problem or a minor problem undergoing the same procedure again. Conclusion: The placement of ureteric stents under LA represents an effective, safe, and well-tolerated alternative to general anaesthesia. The 24/7 availability of a flexible cystoscopy suite, C-arm, and fluoroscopy and specialist urology nurse within a dedicated urology unit has facilitated the delivery of this service.