Procedure, Safety, and Outcomes of Patient-Controlled Sedation in Ureteroscopic Lithotripsy: A 7-Year Cohort Study

To evaluate the safety, feasibility, and outcomes of ureteroscopic (URS) lithotripsy for distal ureteral stones under patient-controlled sedation (PCS) in a large single-center cohort.

This retrospective observational study included 414 patients who underwent 429 URS lithotripsies under intravenous PCS with propofol and alfentanil between 2017 and 2023. Pre-, peri-, and postoperative variables were assessed, and outcomes were analyzed according to stone-free status using graded definitions. Grade A indicated complete stone-free status with no residual stones on postoperative CT, Grade B included Grade A with residual fragments ≤2 mm, and Grade C included Grades A and B with residual fragments measuring 2.1-4 mm.

The overall absolute stone-free rate was 95% (n = 406; Grade A); when relative stone-free definitions were applied, the rates were 95% (n = 408; Grade B) and 97% (n = 414; Grade C). The rate of complications (Clavien-Dindo ≥III) was 1%, and no adverse events occurred. The procedure was aborted in 1% of cases, and 99% of procedures were completed on an outpatient basis without anesthesiology support. Non-stone-free patients (5%) more frequently had multiple or larger stones and a history of stone disease, although no associations were identified with sedation volume or surgeon experience.

URS lithotripsy under PCS is safe and effective for distal ureteral stones, with a high stone-free rate and low complication rate, and may offer practical advantages in clinical practice.