Introduction: Ureteroscopies are commonly performed under general anesthesia to maximize patient tolerability and minimize surgical complications. However, given the improvements in endoscopic technology and risks associated with general anesthesia, alternate forms of anesthesia have been postulated. We aimed to evaluate the outcomes of ureteroscopy for the entire upper urinary tract under conscious sedation.
Methods: We completed a retrospective cohort study from November 2019 to June 2020 at a tertiary-level hospital. All ureteroscopies that were performed with physician-directed, nursing-administered intravenous sedation were included. Our primary outcome was success rate. Secondary outcomes included: stone-free rate, intra-operative complication rate, hospital admission rate, and sedation requirement. Univariate- and multivariate-adjusted logistic regression analyses were employed.
Results: In total, 99 ureteroscopies were included: 73 (73.7%) for urolithiasis, 24 (24.2%) for urothelial carcinoma, and 2 (2.0%) for ureteric obstruction. The overall success rate was 83.8% (83/99). The stone-free rate was 80.8% (59/73). No intra-operative complications, nor hospital admissions, were reported. The mean amount of sedation required was 3 [interquartile range: 2–4] mg of midazolam and 100 [100–150] µg of fentanyl. On multivariate analysis, midazolam was significantly associated with increased success [odds ratio: 2.496, 95% confidence interval: 1.057–5.892; p=0.037].
Conclusions: For the first time in literature, we have shown that ureteroscopy under conscious sedation is safe and effective when evaluating upper tract pathology. We were limited by our small sample size, selection bias to chose healthy patients, and lack of patient tolerability data. Patient selection is paramount when identifying appropriate candidates for this approach.