Office-based ureteral stent placement under local anesthesia for obstructing stones is safe and efficacious

Abstract

Objective: To evaluate the outcomes of urgent ureteral stent placement under local anesthesia (LA) with those placed under general anesthesia (GA) for obstructing stones.

Materials and methods: After institutional review board approval, ureteral stents placed from January 2007 to July 2011 at our institution were reviewed. Only primary stent placement for obstructing renal or ureteral calculi was included in the present analysis. Data were evaluated for 2 groups: GA and LA. The primary outcomes were demographics, interval from presentation to stent insertion, interval from stent insertion to stone removal, success and complication rates, and secondary outcomes were costs per encounter.

Results: A total of 119 primary stent insertion procedures in 110 unique patients were assessed; 73 (GA) and 46 (LA). No differences were found in the mean age or sex between the 2 groups. Both GA and LA groups were stented within 12 hours of presentation, at 58% and 54%, respectively (P = .69); and the interval from stent insertion to stone removal was similar in both groups (mean 33 days and 35 days in the GA and LA groups, respectively, P = .79). No significant differences were found in the failure to place the stent between the GA and LA groups (1.3% vs 8.7%, respectively, P = .07). No complications related to stent placement occurred in either group. The average cost per encounter was nearly 4 times greater in the GA group.

Conclusion: Urgent ureteral stent placement for obstructing stones can be safely and effectively performed under LA in the office. Although avoiding GA and reducing costs, this approach did not prolong the interval to definitive stone management.