Flexible ureteroscopy under local anesthesia for stone management: initial exploration and two-year experience

ABSTRACTBackground Flexible ureteroscopy (f-URS) is a minimally invasive surgical technique used for treating urinary tract stones. While general anesthesia (GA) is the standard method used, it comes with risks. Local anesthesia (LA) is a safer and more cost-effective alternative to GA, and its use in f-URS could potentially reduce patients’ risks and increase accessibility to treatment. This study aims to investigate the feasibility, safety, and efficacy of using LA for f-URS in treating stones, as an initial experience in the diagnosis related group (DRG) era of China.Methods Patients who met the inclusion and exclusion criteria and were continuously included in the study Between 2021 and 2023. We analyzed the stone free status, postoperative complication rate, hospitalization costs, and presented key points of the procedure performed under LA that we had summarized over the past two years.Results A study of 614 patients undergoing f-URS under LA for urinary stones in our hospital showed 83.4% stone-free rate with a mean operative time of 44.12 ± 16.63 minutes; 18 patients experienced fever postoperatively, and 12 had ureteral injuries. No severe complication was reported. The cost of LA was found to be only 1.7% of the DRG payment, which is around $40. The highest VAS scores were observed during the sheath insertion, with STAI scores decreasing during and after surgery.Conclusions The study revealed that f-URS administered under LA was a well-tolerated, efficient, safe, and economical procedure. In the DRG era, this new anesthetic option for f-URS provides urologists with a more cost-effective alternative.KEYWORDS: Flexible ureteroscopyF-URSurinary stonelocal anesthesiadiagnosis-related groups Declaration of financial/other relationshipsThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.AcknowledgmentsThe author sincerely thanks every medical staff in the urology department of The First Affiliated Hospital of Chongqing Medical University.Author contributionsYueqiang Peng: writing-original draft. Linfeng Wang: data curation, validation, investigation, software, formal analysis. Jiajia Jin: visualization, investigation. Yu Jiang: writing- reviewing and editing. Qiao Xu: supervision, technical advisor. Lei Yang: Project administration. Jiayu Liu: conceptualization, methodology, supervision, project administration, funding acquisition.Data availability statementThe datasets generated and/or analyzed during the current study are not publicly available due to patients’ privacy policy but are available from the corresponding author on reasonable request.Additional informationFundingThis paper was not funded.