Safety and efficacy of ureteroscopic lithotripsy for ureteral calculi under sedoanalgesia--a prospective study.
OBJECTIVE
To establish the safety and efficacy of ureteroscopic lithotripsy (URSL) under sedoanalgesia.


METHODS
This study was conducted at Department of Urology (Banaras Hindu University, India) among 124 patients with ureteral stones, between July 2000 and August 2003. Majority of the patients (59.68%) presented with lower ureteric calculi, 24.19% presented with upper ureteric calculi and 16.13% had middle ureteric calculi. All patients were given injection diclofenac sodium (75 mg) promethazine hydrochloride (12.5 mg) deep intramuscular 30 minutes the before procedure. Injection midazolam 0.03 mg/kg body weight slowly given intravenously immediately before the procedure for achieving sedation. Injection fentanyl 50 mcg intravenously given slowly just before introducing the ureteroscope into ureter for achieving intravenous analgesia. Patients were observed for few hours after completion of procedure and oral questions were asked as per proforma, which included tolerance, intensity of pain and percentage of pain experienced by the patients. Patients were discharged thereafter.


RESULTS
87.10% of patients opined that the procedure was acceptable. Only 4.84% opined this procedure was painful. According to present pain intensity score (PPI) in this study 79.03 patients experienced only mild pain, 11.29% cases rated procedure as discomforting, 6.45 rated procedure as distressing and only 3.23% rated as horrible procedure. As per visual analogue scale for assessment of pain 80.65 of cases rated only 20% pain score (in a scale of 0-100). 9.68% cases rated 30% and 6.45% rated 50%. Only two patients in middle ureteric group rated 100% pain. Overall success rate in fragmenting stone was 91.94, where as for lower ureteric calculi it was 97.30%; for upper and, middle ureteric calculi it was 86.66% and 80%, respectively.


CONCLUSIONS
Ureteroscopic lithotripsy can be performed on day care basis under sedoanalgesia which is fairly tolerated by the patients with unremarkable complications and difficulty.
Rao
M Prasad
MP
Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India.
Kumar
Sanjeev
S
Dutta
Biswajeet
B
Vyas
Nachiket
N
Nandy
Priya Ranjan
PR
Mahmood
Mufti
M
Dwivedi
U S
US
Singh
D K
DK
Singh
P B
PB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D011446:Prospective Studies; D012449:Safety; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy
D006993:Hypnotics and Sedatives; D008874:Midazolam