Feasibility and outcome of emergency ureteroscopic removal of lower ureteral stone under intravenous sedation: A prospective study

Abstract

Objective: To compare the efficacy of emergency ureteroscopy (URS) with that of elective URS in the treatment of distal ureteral calculi.
Patients and methods: This prospective study included 132 patients diagnosed with a distal unilateral ureteral stone ≤5 mm and treated with either emergency or elective URS between August 2013 and July 2014. The indication for emergency URS was intractable renal pain not responding to narcotic analgesia. Children, pregnant women and patients with bilateral disease were excluded. The patients were categorized into two groups: Group I included 42 patients who underwent emergency URS under intravenous sedation, while Group II included 90 patients who underwent elective URS. The patients’ demographic data, the stone criteria, perioperative complications, procedure outcome and degree of patient satisfaction were recorded and statistically analyzed.
Results: The mean stone size was 4.2 ± 0.5 mm in Group I and 4.1 ± 0.6 mm in  Group II. The success rate was 90.5% and 97.8% in Groups I and II, respectively with a statistically insignificant difference. Complete stone retrieval without  fragmentation was achieved in 83.3% in Group I and in 82.2% in Group II. The stone migrated proximally in 4 patients in Group I and in only 2 patients of Group II; these patients received ureteral stents. Mucosal injury was observed in 3 and 4 patients of Groups I and II, respectively. Thirty-seven patients of Group I (88%) reported that they were satisfied with the procedure and its outcome compared to 78 patients of Group II (87%).
Conclusion: Emergency URS under intravenous sedation is feasible, safe and equally effective when compared to elective URS for small lower ureteral stones.

Keywords: Emergency URS; Elective URS; Ureteral stone; Intravenous sedation