Skip to main content
SpringerLink
Log in

The initial experience of 4.5/6.5 Fr ureteroscopic laser lithotripsy under topical intraurethral anesthesia supplemented by preoperative and intraoperative medications

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To assess the safety and effectiveness of the 4.5/6.5 Fr ureteroscopic laser lithotripsy (URSL) under topical intraurethral anesthesia (TIUA) compared to spinal anesthesia (SA).

Methods

A retrospective study was conducted on 47 (TIUA: SA = 23:24) patients receiving 4.5/6.5 Fr URSL from July 2022 to September 2022. For the TIUA group, atropine, pethidine, and phloroglucinol were used apart from lidocaine. In the SA group, patients received lidocaine and bupivacaine. We compare the two groups including stone-free rate (SFR), procedure time, anesthesia time, overall operative time, hospital stay, anesthesia failure, intraoperative pain, need for additional analgesia, cost, and complications.

Results

The conversion rate in the TIUA group was 4.35% (1/23). SFR was 100% in both groups. Surgical waiting time and anesthesia time were longer in the SA group (P < 0.001). There were no statistical differences in operational time and intraoperative pain. Patients developed grade 0–1 ureteral injuries. Post-surgical time out of bed was noticeably faster in the TIUA group (P < 0.001). The post-operative complication rate including vomiting and back pain was lower in the TIUA group (P = 0.005).

Conclusion

TIUA had an equal surgical success rate and controlled patients’ intraoperative pain as SA. It was superior in terms of TIUA’s patient admission, waiting time for surgery, anesthesia time, post-operative time out of bed, low complications, and costs, especially for females.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding aurhor, Lijun Qu, upon reasonable request.

References

  1. Raheem OA et al (2017) Burden of urolithiasis: trends in prevalence, treatments, and costs. Eur Urol Focus 3:18–26. https://doi.org/10.1016/j.euf.2017.04.001

    Article  PubMed  Google Scholar 

  2. Reis Santos JM (2018) Ureteroscopy from the recent past to the near future. Urolithiasis. 46:31–37. https://doi.org/10.1007/s00240-017-1016-8

    Article  CAS  PubMed  Google Scholar 

  3. Donaldson JF, Lardas M, Scrimgeour D, Stewart F, MacLennan S, Lam TBL, McClinton S (2015) Systematic review and meta-analysis of the clinical effectiveness of shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for lower pole renal stones. Eur Urol 67(4):612–616

    Article  PubMed  Google Scholar 

  4. Pak CYC (1998) Kidney stones. Lancet 351:1797–1801. https://doi.org/10.1016/s0140-6736(98)01295-1

    Article  CAS  PubMed  Google Scholar 

  5. Kilinc MF et al (2016) The effect of ureteroscope size in the treatment of ureteral stone: 15-year experience of an endoscopist. Turk J Urol. 42:64–69. https://doi.org/10.5152/tud.2016.84594

    Article  PubMed  PubMed Central  Google Scholar 

  6. Vogeli T-A, Mellin H-E, Hopf B (1993) Ureteroscopy under local anaesthesia with and without intravenous analgesia. Br J Urol 72:161

    Article  CAS  PubMed  Google Scholar 

  7. Uzun H, Akca N (2018) Is the 4.5-F ureteroscope (ultra-thin) an alternative in the management of ureteric and renal pelvic stones? Arab J Urol 16:429–434. https://doi.org/10.1016/j.aju.2018.04.006

    Article  PubMed  PubMed Central  Google Scholar 

  8. Karakan T et al (2016) Evaluating ureteral wall injuries with endoscopic grading system and analysis of the predisposing factors. J Endourol 30:375–378. https://doi.org/10.1089/end.2015.0706

    Article  PubMed  Google Scholar 

  9. Turk C et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69:475–482. https://doi.org/10.1016/j.eururo.2015.07.041

    Article  PubMed  Google Scholar 

  10. Yalinkaya F, Topalolu H, Ozmen E (1996) Is general anaesthesia necessary for URS in women. Int Urol Nephrol 28:153–156

    Article  Google Scholar 

  11. Merry AF, Mitchell SJ (2018) Complications of anaesthesia. Anaesthesia 73(Suppl 1):7–11. https://doi.org/10.1111/anae.14135

    Article  PubMed  Google Scholar 

  12. Auge BK, Pietrow PK, Lallas CD (2004) Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 18:33–36

    Article  PubMed  Google Scholar 

  13. Dellabella M, Milanese G, Muzzonigro G (2005) Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol 174:167–172. https://doi.org/10.1097/01.ju.0000161600.54732.86

    Article  CAS  PubMed  Google Scholar 

  14. Shafique MN, Hussain M (2018) Efficacy of tamsulosin alone versus tamsulosin phloroglucinol combination therapy for medical expulsion of lower ureteral calculi. Pak J Med Sci. 34:393–398. https://doi.org/10.12669/pjms.342.14134

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tomiyama Y et al (2004) Effects of cholinergic drugs on ureteral function in anesthetized dogs. J Urol 172:1520–1523. https://doi.org/10.1097/01.ju.0000132564.27665.fb

    Article  CAS  PubMed  Google Scholar 

  16. Dinges HC et al (2019) Side effect rates of opioids in equianalgesic doses via intravenous patient-controlled analgesia: a systematic review and network meta-analysis. Anesth Analg 129:1153–1162. https://doi.org/10.1213/ANE.0000000000003887

    Article  CAS  PubMed  Google Scholar 

  17. Preminger GM et al (2007) 2007 Guideline for the management of ureteral calculi. Eur Urol 52:1610–1631. https://doi.org/10.1016/j.eururo.2007.09.039

    Article  PubMed  Google Scholar 

  18. Drake T et al (2017) What are the benefits and harms of ureteroscopy compared with shock-wave lithotripsy in the treatment of upper ureteral stones? A Systematic Review. Eur Urol 72:772–786. https://doi.org/10.1016/j.eururo.2017.04.016

    Article  PubMed  Google Scholar 

  19. Anthony Rodgers NW, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321:1–12

    Google Scholar 

  20. Ogreden E et al (2020) Early ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi. Int Urol Nephrol 52:15–19. https://doi.org/10.1007/s11255-019-02298-9

    Article  CAS  PubMed  Google Scholar 

  21. Moraitis A, Hultin M, Wallden J (2020) Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine. BMC Anesthesiol 20:242. https://doi.org/10.1186/s12871-020-01154-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Turnbull DK, Shepherd DB (2003) Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 91:718–729. https://doi.org/10.1093/bja/aeg231

    Article  CAS  PubMed  Google Scholar 

  23. Lu P et al (2020) Clinical efficacy and safety of flexible ureteroscopic lithotripsy using 365 mum holmium laser for nephrolithiasis: a prospective, randomized, controlled trial. World J Urol 38:481–487. https://doi.org/10.1007/s00345-019-02776-w

    Article  PubMed  Google Scholar 

  24. Wu Y et al (2021) Ureteroscopic lithotripsy combined with paravertebral block anesthesia or general anesthesia: a propensity matched case-control study. Asian J Surg 44:1370–1375. https://doi.org/10.1016/j.asjsur.2021.03.001

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The study was supported by the Basic and Applied Basic Research Project of Guangzhou Basic Research Program (No. 804907).

Author information

Author notes

  1. Yuan Qu and Quansheng Fu shared first authorship and contributed equally to this work.

  2. Zheng Chen and Lijun Qu shared corresponding author and contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, The First Affiliated Hospital of Jinan University, 613 W. Huangpu Avenue No. 4 Bldg, 6th floor, Guangzhou, China

    Yuan Qu, Quansheng Fu, Xiaoping Qin, Yumin Zhuo, Zheng Chen & Lijun Qu

Authors
  1. Yuan Qu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Quansheng Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaoping Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yumin Zhuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zheng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lijun Qu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: LQ, QF. Methodology: ZC. Formal analysis and investigation: YQ. Writing—original draft preparation: YQ. Writing—review and editing: ZC. Funding acquisition: LQ. Resources: YZ. Supervision: XQ, YZ.

Corresponding authors

Correspondence to Zheng Chen or Lijun Qu.

Ethics declarations

Conflict of interest

The authors declare there are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qu, Y., Fu, Q., Qin, X. et al. The initial experience of 4.5/6.5 Fr ureteroscopic laser lithotripsy under topical intraurethral anesthesia supplemented by preoperative and intraoperative medications. Int Urol Nephrol 55, 1677–1684 (2023). https://doi.org/10.1007/s11255-023-03629-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-023-03629-7

Keywords

Search

Navigation