J S Sandhu1, Ajit K Singh2, Abhijit Bhatulkar3, Uday Pratap4, Milind Chauhan4. 1. Senior Advisor (Surgery & Urology), Command Hospital (Eastern Command), Kolkata 700027, India. 2. Senior Advisor (Anesthesia & Critical Care), Base Hospital, Delhi Cantt 110001, India. 3. Senior Resident (Surgery), Command Hospital (Central Command), Lucknow 226002, India. 4. Resident (Surgery), Command Hospital (Central Command), Lucknow 226002, India.
Abstract
BACKGROUND: Ureteroscopic management of ureteral calculi using topical anaesthesia has been described. Most studies topically anaesthetized the urethra or urinary bladder by instilling 2% of plain lignocaine. In addition to the success rate, the pain perception in these studies was reported subjectively using non-standard criteria. Topical anaesthesia of the ipsilateral ureter and the pelvicalyceal system (PCS), in addition to urethra and urinary bladder, and use of alkalinised lignocaine, for enhanced effect, has not been reported for ureteroscopy. Using these conceptual alterations, we tested the safety and efficacy of performing ureteroscopy and laser lithotripsy under our technique of total intraluminal topical anaesthesia (TILTA). METHODS: One hundred sixty-eight patients underwent ureteroscopic laser lithotripsy by topical instillation of alkalinised lignocaine into the urinary bladder and ipsilateral ureter and PCS. Self-assessed pain perception and changes in vital parameters were objectively scored at various times. The success rate, reasons for failure, maximum pain scores, complications, and willingness to undergo repeat procedure were recorded. RESULTS: The success rate was 91.3% with a mean duration of 14.7 minutes Double J Stent (DJS) was placed in 38.1%. 61.3% patients did not need any postoperative injectable analgesic, with 11.3% requiring more than a single dose. The intraoperative changes in vitals initially and at the height of pain were not statistically significant (p>0.05). Self-assessed median pain scores between intravenous access placement and ureteroscopy were significantly different (p<0.05). CONCLUSIONS: Ureteroscopy, effectively performed under TILTA, is safe with a high success rate. The acceptable pain tolerance and the shortened convalescence in addition makes the procedure's success worth the pain.
BACKGROUND: Ureteroscopic management of ureteral calculi using topical anaesthesia has been described. Most studies topically anaesthetized the urethra or urinary bladder by instilling 2% of plain lignocaine. In addition to the success rate, the pain perception in these studies was reported subjectively using non-standard criteria. Topical anaesthesia of the ipsilateral ureter and the pelvicalyceal system (PCS), in addition to urethra and urinary bladder, and use of alkalinised lignocaine, for enhanced effect, has not been reported for ureteroscopy. Using these conceptual alterations, we tested the safety and efficacy of performing ureteroscopy and laser lithotripsy under our technique of total intraluminal topical anaesthesia (TILTA). METHODS: One hundred sixty-eight patients underwent ureteroscopic laser lithotripsy by topical instillation of alkalinised lignocaine into the urinary bladder and ipsilateral ureter and PCS. Self-assessed pain perception and changes in vital parameters were objectively scored at various times. The success rate, reasons for failure, maximum pain scores, complications, and willingness to undergo repeat procedure were recorded. RESULTS: The success rate was 91.3% with a mean duration of 14.7 minutes Double J Stent (DJS) was placed in 38.1%. 61.3% patients did not need any postoperative injectable analgesic, with 11.3% requiring more than a single dose. The intraoperative changes in vitals initially and at the height of pain were not statistically significant (p>0.05). Self-assessed median pain scores between intravenous access placement and ureteroscopy were significantly different (p<0.05). CONCLUSIONS: Ureteroscopy, effectively performed under TILTA, is safe with a high success rate. The acceptable pain tolerance and the shortened convalescence in addition makes the procedure's success worth the pain.
Authors: J Curtis Nickel; Robert Moldwin; Soledad Lee; Edward L Davis; Richard A Henry; Michael G Wyllie Journal: BJU Int Date: 2008-11-13 Impact factor: 5.588