Evaluation of spinal vs general anaesthesia for retrograde intrarenal procedures
Keywords:
renal stone, anesthesia, spinal anesthesia, generalAbstract
Patients diagnosed with kidney stones and having retrograde intrarenal surgery (RIRS) were the subjects of this research, which sought to evaluate spinal anaesthesia (SA) with general anaesthesia (GA) in terms of cost, success rate, effectiveness, and dependability.
We conducted a retrospective analysis of 82 patients who had RIRS at our clinic after a kidney stone diagnosis between 2020 and 2023. Time until stone fragmentation, duration of hospital stay, number of treatments needed, percentage of stones removed, frequency of complications, cost of anaesthesia, and length of operation were some of the metrics used to compare the groups.
Patients in the SA group had significantly older average ages and higher mean American Society of Anesthesiologists stages (P = 0.009, P = 0.024) compared to those in the GA group. When comparing the groups according to surgical time, stone fragmentation time, intraoperative double-J stent necessity, duration of hospital stay, and stone-free rate, there was no statistically significant difference (P > 0.05). Significantly, the SA group had a reduced anaesthesia cost (P < 0.001). In terms of the occurrence of complications, there was no statistically significant difference between the groups (P > 0.05).
One practical and efficient method for removing kidney stones is RIRS in conjunction with SA. Similar to RIRS given with GA, this method has a high success rate and a low complication rate. Since SA may be safely and effectively done with lower morbidity rates and much less cost than GA, we favour it for patients with comorbidities
References
Breda A, Ogunyemi O, Leppert JT, Schulam, PG. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol. 2009;55(5):1190-97.
Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S et al. Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World Journal of Urology. 2013;31(6):1581-16.
Rodgers A, Walker N, Schug S, McKee A, Kehlet H, Van Zundert A et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493.
Lim SH, Jeong BC, Seo SI, Jeon SS, Han DH. Treatment outcomes of retrograde intrarenal surgery for renal stones and predictive factors of stone-free. Korean Journal of Urology. 2010;51(11):777-82.
Resorlu B, Unsal A, Gulec H, Öztuna D. A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the “resorlu-unsal stone score”. Urology. 2012;80(3):512-18.
Martin F, Hoarau N, Lebdai S, Pichon T, Chautard D, Cult T et al. Impact of lower pole calculi in patients undergoing retrograde intrarenal surgery. Journal of Endourol. 2014;28(2):141-15.
Caskurlu T, Atis G, Arikan O, Pelit ES, Kilic M, Gurbuz C. The impact of body mass index on the outcomes of retrograde intrarenal stone surgery. Urology 2013; 81(3):517-21.
Kuzgunbay B, Turunc T, Akin S, Ergenoglu P, Aribogan A, Ozkardes H. Percutaneous nephrolithotomy under general versus combined spinal-epidural anesthesia. Journal of Endourology. 2009;23(11):1835-38.
Singh V, Sinha RJ, Sankhwar SN, Malik A. A prospective randomized study comparing percutaneous nephrolithotomy under combined spinal-epidural anesthesia with percutaneous nephrolithotomy under general anesthesia. Urologia İnternationalis. 2011;87(3):293-98.
Nouralizadeh A, Ziaee SAM, Hosseini Sharifi SH, Basiri A, Tabibi A, Sharifiaghdas F et al. Comparison of percutaneous nephrolithotomy under spinal versus general anesthesia: a randomized clinical trial. Journal of Endourol. 2013;27(8): 974- 78.
Zeng G, Zhao Z, Yang F, Zhong W, Wu, W, Chen W. Retrograde intrarenal surgery with combined spinal-epidural vs general anesthesia: a prospective randomized controlled trial. Journal of Endourol. 2015;29(4):401-05.
Mohamed MHAT, Al-Hamri S, Askar A, Al-Rawagadh, M. Spinal versus general anesthesia for retrograde intrarenal surgery: A prospective double blinded randomized-controlled trial. Eur Urol Suppl 2018;17(2);e1393
Bosio A, Destefanis P, Alessandria E, Carchedi M, Buffardi A, Dalmasso E et al. Retrograde intrarenal surgery (RIRS) in spinal anesthesia: A feasible and effective stone treatment in one-day surgery. Eur Urol Suppl. 2013;12;e431.