Fluoroless Ureteroscopy Under Local Anesthetic Gel: Experience from a Canadian Tertiary Referral Center

Flexible ureteroscopy (URS) is the backbone of diagnosing upper urinary tract pathologies. Recent advancements in scope design have led to smaller, more maneuverable scopes with enhanced precision. The aim of this study was to assess feasibility of fluoroless URS under a local anesthetic (LA) gel. A prospective cohort study was performed at a Canadian tertiary care center. All patients booked for a diagnostic URS were included in this study. All patients were given intraurethral local lidocaine gel and instructed to signal if discomfort was encountered. Data collected include age, gender, indications of URS, history of URS, ureteral stenting, comorbidity index, and the use of a guidewire, as well as pain using a visual analog scale. A total of 61 URSs using LA were performed on 38 patients. The majority of patients were men (68.9%). Indications for URS were to rule out upper tract urothelial cancer (47.5%), stricture (32.8%), or urolithiasis (19.7%). The average pain score, as rated by the visual analog scale, was 2.05 (standard deviation = 2.037). Only one patient did not want to continue his URS under LA. Guidewire use was associated with an average increase of 1.87 in pain score when compared with freehand URS (β = 1.869, standard error [SE] = 0.610, t = 3.063, p = 0.004, r_partial = 0.398). Male patients reported a 1.38 decrease in pain scores compared with female patients (β = -1.380, SE = 0.615, t = -2.244, p = 0.029, r_partial = -0.302). LA URS was well tolerated in our patient population. Randomized controlled trials on URS with LA vs general or spinal anesthesia are needed to broaden its use, increase accessibility, and improve health care resource utilization.