Improved patient-reported and surgical outcomes following urological procedures under conscious sedation
Kapilan Panchendrabose1, Andrew Pierce1, Raman Grewal2, Naomi T. Gebru2, Kunal Jain3, Ruben Blachman-Braun3, Marc Eric Saltel3, Brian Peters3, Robert Bard3, Jeffery Saranchuk3, Premal Patel3.
1Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; 2Department of Biological Sciences, University of Manitoba, Winnipeg, MB, Canada; 3Department of Surgery , University of Manitoba, Winnipeg, MB, Canada
Parts of this study will be presented at the 37th Annual European Association of Urology Congress..
Introduction: The current standard of care for patients undergoing the majority of endourological, scrotal, and penile procedures is to administer general/spinal anesthesia. Our center previously demonstrated the feasibility of performing distal ureteroscopy under physician-directed, nurse-administrated intravenous (IV) conscious sedation for ureteric calculi. We have expanded our ability to perform a myriad of urological procedures under conscious sedation. This study sought to prospectively evaluate patient-reported and surgical outcomes.
Methods: We prospectively enrolled patients undergoing endourological, ureteric stent insertions/exchanges, scrotal/penile, urethral dilations, and advanced cystoscopic procedures. All procedures were conducted using fentanyl, midazolam, or both, and patient and procedural data were recorded upon completion. Patients were telephoned 4–6 weeks after their procedure to complete a standardized questionnaire. A multivariable-adjusted logistic regression analysis was performed to evaluate whether a patient would opt for conscious sedation again as opposed to general/spinal anesthesia.
Results: A total of 196 procedures were performed, with an overall procedure success rate of 96.5% and a complication rate of 0%. At 4–6-week followup, 83.4% completed the standardized patient tolerability questionnaire. If requiring a repeat procedure of this nature, 85% reported they would opt for conscious sedation as compared to general anesthesia. Predictors of opting for conscious sedation in the future were older age (p=0.017) and surgeon-perceived level of patient tolerability (p<0.001). No statistically significant difference was found with respect to body mass index, gender, prior conscious sedation experience, Charlson Comorbidity Index, type of procedure, or time of procedure.
Conclusions: Physician-directed, nursing-administered IV conscious sedation is a viable alternative for a majority of urological procedures. Careful patient selection is paramount to ensure a successful procedure with excellent patient tolerability.
