Indications and Outcomes of Local Anesthetic Retrograde Ureteral Stent Insertion: A Systematic Review from EAU Endourology.

Abstract

Introduction and Objectives: To evaluate the indications and clinical outcomes of local anesthetic stenting in urological procedures, assessing its effectiveness, adverse effects, and patient tolerance. Materials and Methods: The systematic review was conducted in line with Cochrane and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. MEDLINE, CINAHL, EMBASE, and the Cochrane Central Register were searched up to September 2024 (PROSPERO-CRD42024596866). Studies with at least five patients, focusing on Double-J stent placement or exchange under local anesthesia, published in English, were included. Case reports, reviews, pediatric studies, and redundant older data were excluded. Data on study characteristics, patient demographics, procedural details, and outcomes, including success and complication rates, were extracted. Results: A total of 1725 patients and 1873 ureteral units were included, with studies that varied in sample size (6-463 patients) and included both stent placements (77.6%) and exchanges (22.4%). The overall success rate for local anesthetic stenting was 89%, with failure rates averaging 11%. Of reported studies, complications were reported in 8.68% (n = 76), predominantly Clavien-Dindo Grades I-II (5.94%) and III-IV (2.74%). Lidocaine jelly was the primary local anesthetic, with adjunct pharmacological interventions in some studies. Fluoroscopic guidance was used in 86.3% of cases, and both flexible and rigid cystoscopes were employed. Cost analysis consistently demonstrated significant cost savings with local anesthesia compared to general anesthesia. Patient satisfaction and pain scores showed variability, with many studies highlighting minimal discomfort and a strong willingness among patients to undergo the procedure again. Conclusions: Local anesthetic stenting is an effective alternative to general anesthesia, achieving a good success rate with a low risk of major complications. Although it offers significant cost savings and patient satisfaction is usually high, it does highlight the need for careful patient selection and counseling.