Livadas Kostantinos E, Varkarakis Ioannis M, Skolarikos Andreas, Karagiotis Evangelos, Alivizatos Gerasimos, Sofras Fragiskos, Deliveliotis Charalambos, Bissas Apostolos
Second Department of Urology, Athens Medical School, Sismanoglio Hospital, Athens, Greece.
J Urol. 2007 Nov;178(5):1998-2001. doi: 10.1016/j.juro.2007.07.027. Epub 2007 Sep 17.
In the outpatient office setting we evaluated the feasibility and efficacy of ureteroscopic removal of upward migrated ureteral stents using local or no anesthesia.
Prospectively 37 patients with mild upward stent migration underwent ureteroscopic stent removal under local or no anesthesia. Stent migration was always below the pelvic brim. It was diagnosed by plain x-ray of the kidneys, ureters and bladder, and flexible cystoscopy. Semirigid ureteroscopy was performed in the office outpatient setting. After each procedure patients graded the discomfort and/or pain level experienced by completing 2 separate 5-scale visual analog pain scores, including 1 for flexible cystoscopy and 1 for the ureteroscopic procedure. Pain scores were compared between the 2 procedures.
Stent removal was successful in 34 of 37 patients (91.9%). Successful procedures were never interrupted due to pain intolerance. No complications occurred. The mean visual analog pain score for ureteroscopic stent removal was 1.73 and it was similar in men and women (p = 0.199). The mean visual analog pain score for flexible cystoscopy was 1.27. This procedure was significantly more painful in men than in women (p = 0.018). Ureteroscopic stent removal was more painful than flexible cystoscopy overall and in women (each p <0.01) but not in men (p = 0.3). All patients were discharged home within 1 hour after the procedure and no patient required hospital admission or a new hospital visit.
Ureteroscopic removal of a migrated stent using local anesthesia is effective, safe and tolerable in select patients. Preventing the complications and costs associated with general or spinal anesthesia makes this option appealing to patients and it should be offered when possible.
在门诊环境中，我们评估了在局部麻醉或不使用麻醉的情况下，输尿管镜取出向上移位的输尿管支架的可行性和有效性。
前瞻性地对37例输尿管支架轻度向上移位的患者在局部麻醉或不使用麻醉的情况下进行输尿管镜支架取出术。支架移位均在骨盆边缘以下。通过肾脏、输尿管和膀胱的X线平片以及软性膀胱镜检查进行诊断。在门诊环境中进行半硬性输尿管镜检查。每次手术后，患者通过完成2个单独的5级视觉模拟疼痛评分来对所经历的不适和/或疼痛程度进行分级，其中1个用于软性膀胱镜检查，1个用于输尿管镜检查。比较这两种手术的疼痛评分。
37例患者中有34例（91.9%）成功取出支架。成功的手术从未因疼痛不耐受而中断。未发生并发症。输尿管镜支架取出术的平均视觉模拟疼痛评分为1.73，男性和女性相似（p = 0.199）。软性膀胱镜检查的平均视觉模拟疼痛评分为1.27。该手术在男性中比在女性中疼痛明显更严重（p = 0.018）。总体而言，输尿管镜支架取出术比软性膀胱镜检查更疼痛，在女性中也是如此（p均<0.01），但在男性中并非如此（p = 0.3）。所有患者在手术后1小时内出院回家，没有患者需要住院或再次就诊。
对于部分患者，在局部麻醉下通过输尿管镜取出移位的支架是有效、安全且可耐受的。避免与全身麻醉或脊髓麻醉相关的并发症和费用，使得这种选择对患者有吸引力，应尽可能提供给患者。
