Effect of the Anesthetic Method on the Outcomes of Ureteroscopy for Proximal Ureteral Stones: A Multi-center Study of the Society of Urological Surgery Aegean Study Group

Abstract

What's known on the subject? and What does the study add? Objective: To analyze the effect of the anesthesia method (spinal and general) on the outcome of ureteroscopy (URS) in patients treated for proximal ureteral stones. Materials and Methods: Patients, who underwent URS for proximal ureteral stones at various urology clinics in Turkiye, were included in the study. The patients were divided into two groups according to the anesthesia method performed; the procedure was performed under spinal anesthesia (SA) in group 1 and general anesthesia (GA) in group 2. Patients' demographic, perioperative data and complication rates were compared between the two groups in a retrospective manner. Results: There were 309 and 329 patients in groups 1 and 2, respectively. The mean stone area and Hounsfield unit in GA group were higher (p<0.001 and p=0.007, respectively). In the GA group, the need for double J stent was more frequent (p<0.001). In the SA group, the rate of push-back of stone into the collecting system was higher (p=0.017). According to the Clavien classification system and the others, complication rates were similar between the two groups (p>0.05). The rate of success of URS, which is accepted as complete stone-free status, was higher in the SA group (p=0.041). Conclusion: URS, which is used in the treatment of proximal ureteral stones, has a high success rate, independent of the anesthesia method used. It is important to keep in mind the patient's comorbidities prior to selecting the anesthesia method and that the stone area and the Hounsfield unit are the important factors affecting the outcomes. Ureteroscopy is an effective method for the treatment of proximal ureteral stones and provides high stone-free rates. Many factors affecting the success of ureteroscopy have been discussed extensively in the literature. The anesthetic method considered to be one of these factors is also discussed, but mostly general and spinal anesthesia were compared with local anesthesia. The purpose of this study was to compare the impact of spinal and general anesthesia on ureteroscopy performed for the treatment of proximal ureter stones and it concluded that both methods are safe and effective.