title: Ureteroscopic removal of mildly migrated stents using local anesthesia only.
abstract: OBJECTIVE
  In the outpatient office setting we evaluated the feasibility and efficacy of ureteroscopic removal of upward migrated ureteral stents using local or no anesthesia.
  
  
  METHODS
  Prospectively 37 patients with mild upward stent migration underwent ureteroscopic stent removal under local or no anesthesia. Stent migration was always below the pelvic brim. It was diagnosed by plain x-ray of the kidneys, ureters and bladder, and flexible cystoscopy. Semirigid ureteroscopy was performed in the office outpatient setting. After each procedure patients graded the discomfort and/or pain level experienced by completing 2 separate 5-scale visual analog pain scores, including 1 for flexible cystoscopy and 1 for the ureteroscopic procedure. Pain scores were compared between the 2 procedures.
  
  
  RESULTS
  Stent removal was successful in 34 of 37 patients (91.9%). Successful procedures were never interrupted due to pain intolerance. No complications occurred. The mean visual analog pain score for ureteroscopic stent removal was 1.73 and it was similar in men and women (p = 0.199). The mean visual analog pain score for flexible cystoscopy was 1.27. This procedure was significantly more painful in men than in women (p = 0.018). Ureteroscopic stent removal was more painful than flexible cystoscopy overall and in women (each p <0.01) but not in men (p = 0.3). All patients were discharged home within 1 hour after the procedure and no patient required hospital admission or a new hospital visit.
  
  
  CONCLUSIONS
  Ureteroscopic removal of a migrated stent using local anesthesia is effective, safe and tolerable in select patients. Preventing the complications and costs associated with general or spinal anesthesia makes this option appealing to patients and it should be offered when possible.
authors.affiliation: Second Department of Urology, Athens Medical School, Sismanoglio Hospital, Athens, Greece.
authors.forename: Kostantinos E
authors.initials: KE
authors.lastname: Livadas
authors.forename: Ioannis M
authors.initials: IM
authors.lastname: Varkarakis
authors.forename: Andreas
authors.initials: A
authors.lastname: Skolarikos
authors.forename: Evangelos
authors.initials: E
authors.lastname: Karagiotis
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Alivizatos
authors.forename: Fragiskos
authors.initials: F
authors.lastname: Sofras
authors.forename: Charalambos
authors.initials: C
authors.lastname: Deliveliotis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Bissas
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D011475:Prosthesis Failure; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery; D018666:Ureteroscopy / Q000379:methods*; D014567:Urography