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Office-Based Ureteral Stent Insertion Without Fluoroscopy under Minimal Sedation is Safe and Effective
Journal of Endourology ; 36(Supplement 1):A138, 2022.
Article in English | EMBASE | ID: covidwho-2115253
ABSTRACT
Introduction &

Objective:

Acute renal colic due to obstructing stones has been a challenge for urologists to manage during the COVID-19 pandemic. Due to overwhelmed hospital resources, operating room (OR) time and staff became scarce, resulting in prolonged pain and suffering for patients. Early during the pandemic, we instituted an office-based ureteral stent placement protocol to relieve immediate discomfort. Later with less constrained OR availability, we extended this protocol to patients undergoing chronic stent changes. Method(s) Patients who presented with severe renal colic due to obstructing stones were offered immediate office-based ureteral stent placement under minimal sedation. Patients filled a prescription of diazepam 10mg and were brought to the procedure suite 2 hours later. Intramuscular ketorolac 15mg was given and 2% lidocaine lubricant jelly was inserted per urethra. Flexible cystoscopy was performed with a standard 16Fr scope, and the stent was placed through the cystoscope. For the first two cases, a 0.038" hybrid wire and 4.8fr stent were used while subsequently, a 0.035" stiff hydrophilic nitinol wire and 4.5fr stent were used. No intraoperative fluoroscopy was used. After stent placement, KUB X-Ray was done to confirm stent placement. Result(s) Seven patients (4 females, 3 males) with a mean age of 62.5 years and a mean BMI of 31.3 underwent an office-based procedure. Five stent insertions were done for obstructing ureteral stone (unilateral = 4, Bilateral = 1) and 2 stent changes for ureteral stricture and ureteral obstruction due to fibroids. In most cases, it was clear when the wire had gone past the stone, as there was immediate efflux of urine into the bladder. The efficiency of the procedure was greatly increased by changing the wire and stent size. Stent placement failed in one case due to overfilling of the bladder causing acute angulation of the ureteral orifice. The stent was later inserted under general anesthesia. Conclusion(s) Office-based ureteral stent insertion and exchange are safe and effective even in the absence of fluoroscopy. Further studies are needed to investigate predictors of success of office-based stent insertion, along with cost analysis to expand its use routinely.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Journal of Endourology Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Journal of Endourology Year: 2022 Document Type: Article