Ureteroscopic lithotripsy as day care procedure: Our early experience in Regional Institute of Medical Sciences

Abstract

Aim: The aim of this study was to report the outcome of ureteroscopic lithotripsy (URSL) under local anesthesia (LA) as a day care procedure in patients with lower ureteric calculus. Materials and Methods: Patients with lower ureteric calculus attending urology out patient department, Regional Institute of Medical Sciences (RIMS) Hospital during August 2011 to February 2012 underwent URSL under LA-analgesia as day care procedure. The results are analyzed on aspects of perioperative pain, completion of procedure, stone clearance, hospital stay, complications and patient compliance. Institutional ethical clearance and written informed consent for the procedure taken from all patients for the study. Results: A total of 30 patients with lower ureteric calculus size ranging from 8 to 15 mm underwent URSL with Double J stenting under local anesthesia in RIMS urology operation theatre. Twenty four patients completed the procedure in single session, five required two sessions (four with ureteric stricture DJ stent kept for passive dilation and one patient had edematous non visualized ureteric orifice) and another patient converted to open ureterolithotomy due to hard stone resistant to our pneumatic energy. None of the patients required hospital stay following the procedure except for two patients for IV antibiotics. Visual analog scale was mild in 15 patients, moderate in 10 and severe in five patients. Dysuria with transient hematuria was the most common complication; all were managed conservatively on OPD basis. Overall patient compliance for this procedure was excellent. Conclusion: Ureteric colic is a urological emergency in terms of the severe pain experienced by the patient. In view of the long waiting period for routine OT, fear of obstructive uropathy with urosepsis and consequent decrease in renal function, the initiative of URSL as a day care procedure started in our department and our early experience of this procedure in carefully selected patients is having encouraging results.