Tailoring antibiotic prophylaxis for ureteroscopic procedures based on local resistance profiles may lead to reduced rates of infections and urosepsis: mp75‐10

INTRODUCTION AND OBJECTIVES: The insertion of double J ureteral catheters is a common practice in modern urology. Unfortunately, different symptoms may occur with indwelling stents, such as dysuria, hematuria, flank and suprapubic pain. The objective of the present study was to evaluate the safety and efficacy of levobupivacaine as an intravesical instillation in the control of pain and urinary symptoms generated by the ureteral stent. METHODS: 77 patients with double J catheter (Percuflex 26/6 TM, Boston Scientific) after endoscopic treatment of an ureteral stone were randomized into 2 groups. Both groups received standard therapy for catheter discomfort management (paracetamol, ketorolac and tamsulosine). At the end of the procedure group 1 received instillation of 30 cc of saline and group 2 received a dose of 150 mg (30 cc) of intravesical levobupivacaine. Surgeon and patient were blinded for type of instillation received. Symptomatology was evaluate at 4 and 24 hours after the procedure and at the moment of catheter removal. The USSQ survey, in its Spanish-validated version, was used for this purpose. Plasma levels of levobupivacaine were measured at 5, 10, 15 and 20 minutes after instillation in both groups. RESULTS: Both groups were comparable in terms of age, location and size of stone treated , duration of procedure, stone free rate and days of catheter permanence. Statistical analysis showed significant reduction in group 2 regarding the intensity of pain at 4 hours postoperatively (p 1⁄4 0.02). In addition, during the catheter carrying period, those patients in whom the levobupivacaine solution was applied had less alteration in work activities (p 1⁄4 0.03), and less discomfort in the sexual sphere (p 1⁄4 0.01) Plasma levels of levobupivacaine in the 40 patients exposed to the drug were undetectable (<0.1 mg / dL). There were no side effects attributable to intravesical levobupivacaine. CONCLUSIONS: To our knowledge this is the first clinical trial using levobupivacaine in bladder instillation, which demonstrate better pain control in the immediate postoperative period. There is a significant effect on daily life parameters that could allow better tolerance to the catheter during the time it should remain installed. Also, the use of this substance does not imply a higher cost and its safe, without side effects.