Ureteroscopy with Intravenous Sedation for Treatment of Distal Ureteral Calculi: A Safe and Effective Alternative to Shock Wave Lithotripsy

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Abstract
We evaluated the safety, efficacy and patient tolerance of ureteroscopy with intravenous sedation for treatment of distal ureteral calculi. Ureteroscopy with intravenous sedation was performed in 68 patients, with small distal ureteral calculi requiring treatment and in 2 with middle or upper third ureteral calculi. Intravenous sedation and analgesia were achieved with a combination of fentanyl and midazolam. Balloon dilation of the ureter was performed in 38 patients. Ureteroscopy was performed with a 6F rigid ureteroscope. Stone removal was successful in 66 patients (97%). There were no ureteral perforations in patients undergoing successful stone removal and no complications related to intravenous sedation. Tolerance of the procedure was good in 81% of the patients (including 72% of 36 men and 94% of 32 women undergoing ureteroscopy for distal ureteral calculi) and fair in 19%. In select patients with small distal ureteral calculi ureteroscopy offers a safe, effective and well tolerated alternative to shock wave lithotripsy.