Office-Based Endoscopic Urological Procedures Under Local Anesthesia: Prospective Evaluation of Feasibility, Pain, and Patient Preference

Introduction: Several diagnostic and therapeutic endoscopic urological procedures, such as stent placement, ureteroscopy, and bladder stone lithotripsy, can be performed in a hospital, an ambulatory surgery center, in the office with IV sedation, or in the office using only topical anesthesia. The potential benefits of performing procedures in the office setting using topical anesthesia include efficiency and cost reduction. The potential harms are failure to achieve the desired outcome and patient pain. The purpose of our study was to assess the feasibility, safety, pain tolerance, and cost-effectiveness of advanced office endourological procedures. Methods: All patients from September 2022 to July 2023 undergoing certain office-based endoscopic procedures under topical anesthesia, including ureteral stent placement for obstruction, ureteral stent exchange, ureteroscopy with laser lithotripsy, ureteroscopy with tumor ablation, laser ablation of multifocal bladder tumors, laser lithotripsy of bladder stones, nephrostomy tube exchange, and ureteral catheterization for chemotherapy instillation or retrograde ureteropyelography, were prospectively enrolled and evaluated. At the end of every procedure, visual analog scale (VAS) score and procedure location preference were assessed. Complications and facility costs were also assessed. Results: A total of 80 endoscopic procedures were performed, including 11 bladder procedures, 9 ureteroscopies, and 60 stent and nephrostomy procedures. The mean VAS pain score for bladder procedures was 2.4, ureteroscopy procedures 3.9, and stent and nephrostomy procedures 3.3. Patients undergoing bladder and stent/nephrostomy procedures unanimously expressed a preference for the in-office setting. The office setting was also largely preferred in the ureteroscopy procedure cohort (77.8%). There were eight postprocedure calls and two ED visits. One complication and one failed stent placement occurred. Procedure cost savings ranged from $5,309 to $6,009. Conclusions: Performing certain endoscopic urological procedures in an office setting with only the use of topical anesthesia is feasible, safe, well tolerated, and cost-effective when compared with performing these procedures in the operating room or with general anesthesia.