ArticleUrolithiasis2026
Success rate and pain management in ureteroscopic lithotripsy under local anesthesia: a retrospective analysis of 151 consecutive cases.
Article in Urolithiasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Ureteroscopic lithotripsy under local anesthesia combined with multimodal analgesia (LA-URS) offers significant advantages; however, reported success rates vary widely (69.8%-88%), and limited understanding of intraoperative pain sources has hindered broader adoption. This study aimed to evaluate a standardized perioperative protocol for LA-URS and identify key pain sources.We retrospectively analyzed 151 consecutive patients who underwent LA-URS performed by a single surgeon between January 2023 and December 2025. A three-phase perioperative protocol included: (1) preoperative structured communication and psychological preparation; (2) gentle intraoperative manipulation, low-pressure irrigation, and VAS-guided analgesia; and (3) standardized postoperative care. Patients were stratified by endoscope type: flexible ureteroscopy (retrograde intrarenal surgery, RIRS; n = 82) and rigid ureteroscopy (URS, n = 69), based on stone location. Pain intensity was assessed at five key time points.The overall success rate was 98.0% (148/151). Peak pain occurred during ureteral mechanical dilation (VAS 3.68 ± 1.52 during rigid scope advancement), with VAS ≥ 4 in 44.6% of patients. Pain decreased significantly during lithotripsy (VAS 2.03 ± 1.53), with VAS ≥ 4 in 14.9% (66.6% relative risk reduction, P < 0.001). Sheath insertion during RIRS generated pain comparable to lithotripsy. Gender was the only significant predictor of pain (males > females, P = 0.003); age, BMI, and stone size showed no effect. No major complications occurred.This standardized perioperative protocol achieved a 98% success rate for LA-URS. Intraoperative pain primarily resulted from mechanical ureteral dilation rather than lithotripsy; excessive irrigation pressure may exacerbate discomfort. These findings suggest that traditional risk stratification criteria may warrant re-evaluation, and that LA-URS may be applicable to a wider patient population pending prospective validation.While this protocol provides a framework for LA-URS implementation, multicenter prospective validation is needed.
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