Metodología y límites de la ureteroscopia ambulatoria

Abstract

To demonstrate the efficacy of ambulatory ureteroscopy under sedation-analgesia as diagnostic and/or therapeutic procedure for the upper urinary tract diseases, neoplasias, stenosis, stones.We analyze the results of a series of diagnostic and/or therapeutic procedures in 1243 patients divided into five groups: 1. Work up for filling defects with positive cytology and hematuria, 36 cases. 2. Treatment of urinary stones, 1135 cases. 3. Treatment and follow-up of upper urinary tract tumors, 19 cases. 4. Foreign body extraction, 27 cases. 5. Dilation/ section of ureteral stenosis, 26 cases. We perform the procedure under local anesthesia (urethral xylocaine gel), sedation with midazolam and analgesia with remifentanil perfusion (0.08-0.20 mcg kg/minute); the operation is subdivided into three steps: access to the ureter, progression/ureteral examination, and diagnostic and/or therapeutic actions.Fifteen percent of the patients presented pain or intolerance at the start or during the procedure, and they progress to general anesthesia. 10% of the cases have a hospital admission longer than six hours. Ureteroscopy was effective as a diagnostic procedure in 30/36 cases. Ureteroscopy was indicated as elective treatment in 833 cases of ureteral stones (54 lumbar; 248 iliac; 531 pelvic), achieving good results in 93% of the patients; it was indicated for failures or complications of extracorporeal shockwave lithotripsy in 302 cases (73 lumbar; 83 iliac; 146 pelvic), with good results in 98% of the patients. Ureteroscopy was used to treat conservatively low-grade ureteral tumors of the pelvic ureter in 12 cases, or as palliative therapy (7 cases). From the 26 cases of ureteral stenosis, 8 underwent ureterotomy and 18 balloon dilation, leaving a ureteral catheter for 4-6 weeks, obtaining good results in 21 cases.Ureteroscopy is an effective technique in 94% of the cases, and it can be performed as an outpatient procedure for diagnosis or treatment of urinary stones and ureteral stenosis.