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

Area of Science:

• Urology
• Anesthesiology
• Minimally Invasive Surgery

Background:

• Flexible ureteroscopy (f-URS) is a key treatment for urinary stones.
• General anesthesia (GA) carries risks and increases costs.
• Local anesthesia (LA) presents a safer, more accessible alternative.

Purpose of the Study:

• Evaluate the feasibility, safety, and efficacy of LA for f-URS.
• Assess LA's role in the diagnosis-related group (DRG) era in China.
• Determine if LA is a viable alternative to GA for f-URS.

Main Methods:

• Retrospective analysis of 614 patients undergoing f-URS with LA between 2021-2023.
• Evaluation of stone-free rates, postoperative complications, and hospitalization costs.
• Documentation of procedural key points and patient-reported pain scores (VAS, STAI).

Main Results:

• Achieved an 83.4% stone-free rate with an average operative time of 44.12 minutes.
• Reported low complication rates: 18 cases of fever, 12 ureteral injuries, no severe complications.
• LA costs were minimal (1.7% of DRG payment, ~$40), with highest pain during sheath insertion.

Conclusions:

• f-URS under LA is well-tolerated, efficient, safe, and economical.
• LA offers a cost-effective anesthetic option for f-URS in the DRG era.
• This approach enhances treatment accessibility and reduces patient risk.