Primary Ureteric Stent Insertion Under Local Anaesthetic or Sedoanalgesia in Non-pregnancy

Abstract

Background and Objective To characterise the evidence surrounding local anaesthetic ureteric stent insertion (LAUSI) in contexts outside of pregnancy, a procedure typically performed under general anaesthetic (GAUSI), as it has never been the subject of a systematic review. Materials and Methods A systematic review of the Medline, EMBASE, PubMed, AMED, BNI, EMCARE, HMIC and PsycINFO databases was conducted to examine the published evidence in line with the Preferred Reporting Items of Systematic Review and Meta-analyses (PRISMA) guidelines surrounding the technique, patient demographics, setting, type of LA± sedoanalgesia used, cystoscopy and fluoroscopy usage, patient tolerability and pain, efficacy, complications and cost-effectiveness. Around 1,460 papers were systematically screened for inclusion. Results Seventeen studies were identified; one randomised controlled trials (RCT), four non-randomised comparative studies, and 12 case-series describing LAUSI. The 17 studies encompassed a total of some 1545 LAUSI. The clinical indications were similar to those for GAUSI. Successful LAUSI rate ranged from 71-98.9% in studies overall, with a pooled mean success rate of 89.3% overall (86.8% in LA only, 91.75% in LA ± sedoanalgesia). The tolerability of a LAUSI patient across 14 studies had a pooled mean rate of 91.8% (88.6% in LA only, 95% in LA ± sedoanalgesia). The procedure time was reported in seven studies, and it ranged from 5.35±0.87 to 65.0±27.5 minutes. The four comparative studies showed no difference in complication rates between LAUSI and GAUSI. All five studies reporting on cost-effectiveness showed LAUSI to be superior to GAUSI. Conclusions LAUSI is a safe, effective, and cost-effective alternative to GAUSI, which is under-utilised. Further research in the form of RCTs is required to formally establish its place and acceptability amongst urologists.