Transurethral Pneumatic Cystolithotripsy under Local Anaesthesia as a Day-care Procedure: A Retrospective Descriptive Study from North-east India

Introduction: Urinary bladder stones comprise only 5% of all urinary stones but are responsible for 14% of hospital admissions. Various types of treatment for bladder stones include open cystolithotomy, extracorporeal shock wave lithotripsy, cystolitholapaxy, and percutaneous suprapubic or transurethral cystolithotripsy. Aim: To report the safety and intensity of pain associated with transurethral pneumatic cystolithotripsy under local anaesthesia in adult patients as a day-care procedure. Materials and Methods: This retrospective hospital-based descriptive study was conducted in the Department of Urology at the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India, from June 2022 to January 2024, 34 patients (33 men and 1 woman) with symptomatic urinary bladder stones underwent transurethral pneumatic cystolithotripsy under local anaesthesia as a daycare procedure. Patient’s sex, age, symptoms, complete blood count, kidney function tests, random blood sugar, glycated haemoglobin (HbA1c), coagulation profile and urine analysis were collected from hospital records. Stone size and number were collected from kidney, ureter and bladder (KUB) X-ray, ultrasonography and in some cases, intravenous urography and CT scan (non-contrast) reports. Ten minutes after the instillation of 10 mL of 2% lignocaine jelly into the urethra, pneumatic energy was delivered using a 9.5 F semi-rigid ureteroscope (Karl Storz, Germany). Pain during the procedure was assessed using the Visual Analogue Scale (VAS). The operating time and status of fragmentation and clearance of the stone were also recorded. These data were entered and analysed using Microsoft Excel Software version 2019. Continuous variables were presented as mean and standard deviation or range, while categorical variables were expressed as frequencies and percentages. Results: The mean patient age was 38 years, and the mean stone size was 13.9 mm. The mean operating time was 15.4 minutes. Complete stone fragmentation and clearance were achieved in 30 out of 34 patients (88.2%), with a mean VAS score of 2.5. All patients who had a successful procedure had stones ≤20 mm. Mild haematuria was observed in 25 patients (73.5%). There were no bladder perforations and no mortality. The procedure failed in four patients, who subsequently underwent cystolithotripsy under spinal anaesthesia. Conclusion: Transurethral pneumatic cystolithotripsy under local anaesthesia as a day-care procedure was safe and effective. Adult patients tolerated the procedure well. Therefore, it is a viable treatment option for urinary bladder stones of size up to 20 mm in adult patients.