A Systematic Review and Single-Centre Experience of Ureterorenoscopy Under Local Anesthetic: A Safer Option for Anesthetically High-Risk Patients?

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Ali Tasleem
Sachin Yallappa
Michael Mikhail
Tarik Amer
Peter Pietrzak
Peter Acher
Antony Young


Ureteric stones, ureteroscopy, laser, renal stone


Patients are living longer with an increasing number of co-morbidities. Minimally invasive ureterorenoscopy (URS) to manage upper tract calculi or transitional cell carcinoma (TCC) can be performed under general or spinal anaesthesia, however certain co-morbid patients are not suitable for this and may benefit from a different approach. We report on URS under local anaesthesia (LA) using intra-ureteric marcaine as the primary form of anaesthesia. We also aimed to perform a robust systematic review of this topic.


A retrospective analysis over 6 years was undertaken on all patients who underwent URS for calculi or TCC under LA, with the use of intra-urethral lidocaine gel (2%) and intra-ureteric marcaine (0.5%, 20ml) with sedoanalgesia as an adjunct. A systematic review and all English Language articles on ureteroscopic procedures with the use of LA with or without intravenous sedoanalgesia were selected and data extracted.


In our case series, twelve patients had a total of 42 procedures. Stone size varied from 4-35mm. Twenty-two percent of procedures (9/41) did not require any sedation or intravenous analgesia as an adjunct to the bupivacaine with a further 49% (20/41) requiring midazolam. (The anaesthetic chart was not available for one procedure). No procedures were abandoned and there were no conversions to general/spinal anaesthesia. There were no complications secondary to the use of LA. Eighty-one percent of cases (34/42) were performed as day-case or overnight stays. The complication rate was similar to that for conventional anaesthesia. The systematic review yielded 1121 procedures from 11 papers and 7 countries. In 32 cases the procedure was converted to general anaesthesia.  Stone clearance rates were between 78-100%. The procedures were well tolerated in 80-90% of cases.


This study highlights that URS can be safely performed under LA. It is well tolerated and represents an option for carefully selected patients who have been adequately counselled, and who would be at high risk from anaesthesia. Such patients may otherwise be considered “unfit” for endourological intervention.




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1. Wills TE, Burns JR. Ureteroscopy: an outpatient procedure? J Urology 1994;151:1185–7.

2. Goodman TM. Ureteroscopy with paediatric cystoscope in adults. Urology 1977;9:394.

3. Aboumarzouk, Omar M, Bhaskar K. Somani, and Manoj Monga. Flexible ureteroscopy and holmium:yag laser lithotripsy for stone disease in patients with bleeding diathesis: a systematic review of the literature. Int Braz J Urol 2012;38.3:298–306.

4. Yalcinkaya F, Topaloglu H, Ozmen E, Unal S. Is general anaesthesia necessary for URS in women? Int Urol Nephrol 1996;28.2:153–56.

5. Rittenberg, Michael H., David J. Ellis, and Demetrius H. Bagley. Ureteroscopy under local anaesthesia. Urology 1987;30.5:475–78.

6. Hosking DH, Bard RJ. Ureteroscopy with intravenous sedation for treatment of distal ureteral calculi: a safe and effective alternative to shock wave lithotripsy. J Urol 1996;Sep;156(3):899–901; discussion 902.

7. Park, Hyoung Keun et al. Ureteroscopic Lithotripsy under local anaesthesia: analysis of the effectiveness and patient tolerability. Eur Urol 2004;45.5:670–73.

8. Chan PSF, Fenn J. and LI AKC. Transurethral Ureterorenoscopic Lithotripsy and retrieval of ureteric calculi under local anaesthesia and sedation. Br J Urol 1990;65:141–43.

9. Vogeli T-A. et al. Ureteroscopy under local anaesthesia with and without intravenous analgesia. Br J Urol 1993;72.2:161–64.

10. Abdel-Razzak O and Bagley DH. The 6.9 F semirigid ureteroscope in clinical use. Urolog 1993;41(1):45–48.

11. Miroglu C, Saporta L. Transurethral ureteroscopy: is local anaesthesia with intravenous sedation sufficiently effective and safe? Eur Urol 1997;31:36–39

12. Jeong B, Park C, Kwak H. et al. How painful are shockwave lithotripsy and endoscopic procedures performed at outpatient urology clinics? Urological Res 2005;33(4):291–96.

13. Rao MP, Kumar S, Dutta B, et al. Safety and efficacy of ureteroscopic lithotripsy for ureteral calculi under sedoanalgesia – a prospective study. Int Urol Nephrol 2005;37.2:219–24.

14. Gupta PK. Initial experience with a prototype ureteroscope. J Endourol 2006;20.1:9–11.

15. Kroczak TJ, Kamaljot SK, Patel P, and Al-Essawi T. Ureteroscopy with conscious sedation for distal ureteric calculi: 10-year experience. Can Urolog Assoc J. 2016;10(1 2):E12.

16. Ahmed P, Acher P, and Deane A. Ureteric bupivacaine infusion for loin pain haematuria syndrome. Ann Royal Coll Surg Eng 2010;92(2):139–41.