From the Guidelines
Anesthesia for Double J Stent Insertion
The insertion of a double J stent is typically performed under local anesthesia, utilizing 2% lidocaine injected into the urethra and bladder, with or without conscious sedation using midazolam (1-2 mg IV) and fentanyl (25-50 mcg IV) 1.
- The procedure can also be done under general anesthesia, such as propofol (1-2 mg/kg IV) and remifentanil (0.1-0.5 mcg/kg/min IV), in cases where patient anxiety or discomfort is a concern.
- The choice of anesthesia depends on patient factors, such as medical history and anxiety level, as well as the surgeon's preference 2.
- Ureteral stents are used to bypass a blocked or an injured segment of the ureter, thus restoring continuity of flow, and double-J ureteral stents are better tolerated by patients compared to percutaneous nephroureteral catheters 1.
- In some cases, combined procedures with “rendez-vous” techniques or even a one-step antegrade stent placement can yield similar successful alternative approaches 2.
From the Research
Anesthesia for Double J (Ureteral) Stent Insertion
- The type of anesthesia used for Double J (Ureteral) stent insertion can vary depending on the setting and patient factors.
- In some cases, local anesthesia is used, such as in the study by 3, where ketamine for conscious sedation and local anesthesia were used in the Emergency Department, and just local anesthesia was used on the wards.
- Another study by 4 found that ureteral stent placement under local anesthesia in women can be performed safely and effectively, but the procedure is painful and should be proposed only to selected cases.
- The use of local anesthesia for ureteral stent placement has also been reported in other studies, such as 5, where office stent placement under local anesthesia was found to be a safe and efficient procedure for the management of multiple ureteral disorders.
- In contrast, general anesthesia is often used for ureteral stent placement, especially in cases where the procedure is more complex or the patient is not a good candidate for local anesthesia.
- The study by 6 highlights the advantages and disadvantages of internal double-J stents versus external pyeloureteral stents, including the need for general anesthesia for removal of internal double-J stents.
Specific Anesthesia Used
- Ketamine for conscious sedation and local anesthesia were used in the study by 3.
- Intraurethral 2% lignocaine gel was used in the study by 7.
- Lidocaine gel and lidocaine solution were instilled in the bladder 5 minutes before the procedure in the study by 5.
- Local anesthesia was used in the studies by 4 and 5, but the specific type and dosage of anesthesia were not specified.
Settings for Anesthesia Administration
- The study by 3 was conducted in the Emergency Department and on the wards.
- The study by 5 was conducted in an office cystoscopy room.
- The study by 4 was conducted in a hospital setting, but the specific location was not specified.
- The study by 6 was a multicenter study, but the specific settings for anesthesia administration were not specified.