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Background and Objective
To characterise the evidence surrounding local anaesthetic ureteric stent insertion (LAUSI) in contexts outside of pregnancy, a procedure typically performed under general anaesthetic (GAUSI), as it has never been the subject of a systematic review.
Materials and Methods
A systematic review of the Medline, EMBASE, PubMed, AMED, BNI, EMCARE, HMIC and PsycINFO databases was conducted to examine the published evidence in line with the Preferred Reporting Items of Systematic Review and Meta-analyses (PRISMA) guidelines surrounding the technique, patient demographics, setting, type of LA± sedoanalgesia used, cystoscopy and fluoroscopy usage, patient tolerability and pain, efficacy, complications and cost-effectiveness. Around 1,460 papers were systematically screened for inclusion.
Seventeen studies were identified; one randomised controlled trials (RCT), four non-randomised com-parative studies, and 12 case-series describing LAUSI. The 17 studies encompassed a total of some 1545 LAUSI. The clinical indications were similar to those for GAUSI. Successful LAUSI rate ranged from 71-98.9% in studies overall, with a pooled mean success rate of 89.3% overall (86.8% in LA only, 91.75% in LA ± sedoanalgesia). The tolerability of a LAUSI patient across 14 studies had a pooled mean rate of 91.8% (88.6% in LA only, 95% in LA ± sedoanalgesia). The procedure time was reported in seven studies, and it ranged from 5.35±0.87 to 65.0±27.5 minutes. The four comparative studies showed no difference in complication rates between LAUSI and GAUSI. All five studies reporting on cost-effectiveness showed LAUSI to be superior to GAUSI.
LAUSI is a safe, effective, and cost-effective alternative to GAUSI, which is underutilised. Further research in the form of RCTs is required to formally establish its place and acceptability amongst urologists.
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2. Mattei A, Birkhaeuser FD, Baermann C, Warncke SH, Studer UE. To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. J Urol. 2008 Feb;179(2):582–6.
3. Danuser H, Germann C, Pelzer N, Rühle A, Stucki P, Mattei A. One- vs 4-week stent placement after laparoscopic and robot-assisted pyeloplasty: results of a prospective randomised single-centre study. BJU Int. 2014 Jun;113(6):931–5.
4. Abboudi H, Ahmed K, Royle J, Khan MS, Dasgupta P, N’Dow J. Ureteric injury: a challenging condition to diagnose and manage. Nature Reviews Urology. 2013 Feb;10(2):108–15.
5. Croghan SM, Zaborowski A, Mohan HM, Mulvin D, McGuire BB, Murphy M, et al. The sentinel stent? A systematic review of the role of prophylactic ureteric stenting prior to colorectal resections. Int J Colorectal Dis. 2019 Jul;34(7):1161–78.
6. Zimskind PD, Fetter TR, Wilkerson JL. Clinical Use of Long-Term Indwelling Silicone Rubber Ureteral Splints Inserted Cystoscopically. The Journal of Urology. 1967 May 1;97(5):840–4.
7. Tsuchida S, Sugawara H. A new flexible fibercystoscope for visualization of the bladder neck. J Urol. 1973 May;109(5):830–1.
8. Clayman RV, Kramolowsky EV. Bedside flexible cystoscopy: an approach to the critically ill patient. J Urol. 1986 Jun;135(6):1179–80.
9. Reddy PK, Hulbert JC. Retrograde Pyelogram Using the Flexible Cystoscope. The Journal of Urology. 1986 Dec 1;136(6):1283–4.
10. Andriole GL, Bettmann MA, Garnick MB, Richie JP. Indwelling double-J ureteral stents for temporary and permanent urinary drainage: experience with 87 patients. J Urol. 1984 Feb;131(2):239–41.
11. Jarrard DJ, Gerber GS, Lyon ES. Management of acute ureteral obstruction in pregnancy utilizing ultrasound-guided placement of ureteral stents. Urology. 1993 Sep;42(3):263–7; discussion 267-268.
12. John H, Vondruska K, Sulser T, Lauper U, Huch A, Hauri D. Ureteral stent placement in hydronephrosis during pregnancy. Urologe. 1999 Sep 1;38(5):486–9.
13. Ngai H-Y, Salih HQ, Albeer A, Aghaways I, Buchholz N. Double-J ureteric stenting in pregnancy: A single-centre experience from Iraq. Arab Journal of Urology. 2013 Jun 1;11(2):148–51.
14. Laing KA, Lam TBL, McClinton S, Cohen NP, Traxer O, Somani BK. Outcomes of ureteroscopy for stone disease in pregnancy: results from a systematic review of the literature. Urol Int. 2012;89(4):380–6.
15. Wymer K, Plunkett BA, Park S. Urolithiasis in pregnancy: a cost-effectiveness analysis of ureteroscopic management vs ureteral stenting. Am J Obstet Gynecol. 2015 Nov;213(5):691.e1-8.
16. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology*. Anesthesiology. 2016 Feb 1;124(2):270–300.
17. Sinha S, Jaumdally SZ, Cassim F, Wicht J, Kaestner L, Panackal A, et al. Outcomes of outpatient ureteral stenting without fluoroscopy at Groote Schuur Hospital, Cape Town, South Africa. South African Medical Journal. 2018 May 25;108(6):506-510–510.
18. Mcfarlane JP, Cowan C, Holt SJ, Cowan MJ. Outpatient ureteric procedures: a new method for retrograde ureteropyelography and ureteric stent placement. BJU International. 2001;87(3):172–6.
19. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery. 2010 Jan 1;8(5):336–41.
20. Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evidence-Based Medicine. 2018 Apr 1;23(2):60–3.
21. Wells G, Shea B, O’Connell D, Peterson J. The Newcastle-Ottawa (NOS) for assessing the quality of nonrandomised studies in meta-analyses. [Internet]. 2000 [cited 2020 Sep 9]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
22. Pierson DJ. How to read a case report (or teaching case of the month). Respir Care. 2009 Oct;54(10):1372–8.
23. Hill AB. The Environment and Disease: Association or Causation? Proc R Soc Med. 1965 May;58(5):295–300.
24. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ [Internet]. 2019 Aug 28 [cited 2020 Sep 9];366. Available from: https://www.bmj.com/content/366/bmj.l4898
25. Hussein NS, Norazan MR. Impact of Self-Watching Double J Stent Insertion on Pain Experience of Male Patients: A Randomized Control Study Using Visual Analog Scale. ISRN Urol [Internet]. 2013 Apr 15 [cited 2020 Sep 10];2013. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649350/
26. Doersch KM, Thai KH, Machen GL, Bird ET, Reilly TP, El Tayeb MM. A Comparison of Clinical Outcomes of Operating Room Versus Office-based Ureteral Stenting With the Novel Use of Nitrous Oxide Sedation. Urology. 2019 Oct;132:37–42.
27. Sivalingam S, Tamm-Daniels I, Nakada SY. Office-based ureteral stent placement under local anesthesia for obstructing stones is safe and efficacious. Urology. 2013 Mar;81(3):498–502.
28. J C, M A, S L, S L, E B, D G, et al. Double-J ureteral stent under local anesthesia for women [Internet]. Vol. 21, The Canadian journal of urology. Can J Urol; 2014 [cited 2020 Sep 10]. Available from: https://pubmed.ncbi.nlm.nih.gov/24529012/
29. Gershman B, Eisner BH, Sheth S, Sacco DE. Ureteral Stenting and Retrograde Pyelography in the Office: Clinical Outcomes, Cost Effectiveness, and Time Savings. Journal of Endourology. 2013 May 1;27(5):662–6.
30. Giannakopoulos S, Pantazis T, Kalaitzis C, Bantis A, Antoniou DE, Touloupidis S. Outpatient Ureteral Stent Placement under Local Anesthesia Using a Flexible Cystoscope and Fluoroscopic Control. CUR. 2008;2(2):92–6.
31. Sigman DB, Del Pizzo JJ, Sklar GN. Endoscopic retrograde stenting for allograft hydronephrosis. J Endourol. 1999 Feb;13(1):21–5.
32. Adeyoju, Collins, Brooman, O’Reilly. Outpatient flexible cystoscope-assisted insertion of ureteric catheters and ureteric stents. BJU International. 1999;83(7):748–50.
33. Jeong BC, Park HK, Kwak C, Oh S-J, Kim HH. How painful are shockwave lithotripsy and endoscopic procedures performed at outpatient urology clinics? Urol Res. 2005 Aug;33(4):291–6.
34. Nourparvar Paymon, Leung Andrew, Shrewsberry Adam B., Weiss Aaron D., Patil Dattatraya, Atallah Hany, et al. Safety and Efficacy of Ureteral Stent Placement at the Bedside Using Local Anesthesia. Journal of Urology. 2016 Jun 1;195(6):1886–90.
35. Birch BRP, Anson KM, Miller RA. Sedoanalgesia in Urology: A Safe, Cost-effective Alternative to General Anaesthesia. British Journal of Urology. 1990;66(4):342–50.
36. Grasso M, Bagley DH. Flexible Cystoscopic Placement of Ureteral Stents before Shock Wave Lithotripsy. Journal of Endourology. 1990 Jan 1;4(3):229–33.
37. Mark SD, Gray JM, Wright WL. Flexible cystoscopy as an adjunct to extracorporeal shockwave lithotripsy. Br J Urol. 1990 Sep;66(3):245–7.
38. Carrion A, D’Anna M, Costa-Grau M, Luque P, García-Cruz E, Franco A, et al. Office stent placement under local anesthesia is a safe and efficient procedure for the management of multiple ureteral disorders. Actas Urológicas Españolas (English Edition). 2018 Mar 1;42(2):126–32.
39. German K, Hasan ST, Derry C. Cystodiathermy under local anaesthesia using the flexible cystoscope. Br J Urol. 1992 May;69(5):518–20.
40. Wong KA, Zisengwe G, Athanasiou T, O’Brien T, Thomas K. Outpatient laser ablation of non-muscle-invasive bladder cancer: is it safe, tolerable and cost-effective? BJU Int. 2013 Sep;112(5):561–7.
41. Doersch KM, Machen GL, Thai KH, Sung J, El Tayeb MM. Feasibility and clinical outcomes of ureteral stenting in the office procedural suite. Can J Urol. 2018;25(6):9596–600.