A hybrid model of ureteral stent change - ambulatory cystoscopy suite under local anesthesia versus operating room under general or monitored anesthesia.

PURPOSE: Patients with long-term ureteral stents need regular change, traditionally under General Anesthesia (GA). We present a hybrid model where patients are risk-stratified for anticipated technical difficulty: (1) local anesthesia (LA) in the outpatient cystoscopy suite as day procedures, or (2) GA/ Monitored Anesthesia Care (MAC) in operating room (OR).

METHODS

A retrospective review was conducted of ureteral stent changes between 2021 and 2025, using a risk-stratified model: lower-risk as outpatient LA in ambulatory cystoscopy suite, and higher-risk under GA/MAC in the OR.

RESULTS

A total of 569 stent changes were performed: 348 (61%) under LA in cystoscopy suite, and 221 (39%) under GA/MAC in OR. LA cystoscopy suite stent change patients were older (75 vs. 69 years, p  < 0.01), with higher ASA grade (ASA 3/4 = 79 vs. 66%, p < 0.01). There were similar proportions of males (43 vs. 48%) and bilateral ureteral stent changes (15 vs. 16%) (all p > 0.05). Under LA, 335 (96.3%) stent changes were successful, compared with 220 (99.5%) in OR (p < 0.05). Complication rates were similar (3.74 vs. 5.45%, p = 0.35), with most complications being urinary tract infections managed conservatively (Clavien 1/2).

CONCLUSION

A hybrid ureteral stent change model with selected ureteral stent changes performed under LA in the ambulatory cystoscopy suite instead of the OR, is a feasible and safe option. Advantages include avoiding risks of general anesthesia and reducing the duration of hospital stay as an ambulatory day case. LA stent change has cost-savings, conserves hospital resources and can be considered for older and higher ASA risk patients.