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Comparison of Safety and Efficiency of General, Spinal and Epidural Anesthesia Methods Used for The Endoscopic Surgical Treatment of Ureteral Stones: Which One is Better to Access the Ureter and Reach The Stone?

Unal Oztekin, Mehmet Caniklioglu, Fatih Atac, Cigdem Unal Kantekin, Abdullah Gurel, Levent Isikay



Purpose: The aim of this study is to evaluate the effects of anesthesia methods on the surgical results of spinal, epidural, and general anesthesia procedures and the success of urethral access and stone access achievement.

Materials and Methods: In this prospective randomized study, 105 patients who underwent primary URS procedure for ureteral stones were evaluated. The patients were randomized into three groups by permuted block randomization according to the applied anesthesia method: General anesthesia (GA): 33 patients, Spinal anesthesia (SA): 31 patients, and Epidural anesthesia (EA): 31 patients. Ten patients, whose ureteral access was not successful, were dropped out. The success of the three anesthesia methods on the success of the ureter access and its effects on surgical outcomes were compared.

Results: There was no statistically significant difference among the three groups in terms of the demographic values and preoperative features except the American Society of Anesthesiologists (ASA) status. Dilatation and the access time to stone were statistically significantly longer in SA and EA group compared to the GA group. There was no statistically significant difference among the groups in terms of operation, lithotripsy time, stone-free rate (SFR), and complication rates. The Visual Analog Scale (VAS) scores in the 8th and 24th hours were statistically significantly higher in the GA group.

Conclusion: In patients who are decided to undergo primary ureterorenoscopy procedure, it can be suggested to treat with GA to provide a better relaxation of the ureter if there are no contraindications.


Anesthesia Methods, Endoscopic, Ureteral Stone


-Taylor AL, Oakley N, Das S, et al. Day-case ureteroscopy: an observational study. BJU Int 2002; 89:181-5.

- Cheung MC, Lee F, Leung YL, et al. Outpatient ureteroscopy: predictive factors for postoperative events. Urology 2001; 58: 914-8.

- Trinchieri A. Epidemiological trends in urolithiasis: impact on our health care systems. Urol Res 2006;34:151-156.

-Monga M1, Gawlik A, Durfee W. Systematic evaluation of ureteral access sheaths. Urology. 2004 May;63(5):834-6.

-Koo KC, Yoon JH, Park NC,et al. The Impact of Preoperative α-Adrenergic Antagonists on Ureteral Access Sheath Insertion Force and the Upper Limit of Force Required to Avoid Ureteral Mucosal Injury: A Randomized Controlled Study. J Urol. 2018 Jun;199(6):1622-1630.

- Cetti RJ, Biers S, Keoghane SR: The difficult ureter: what is the incidence of pre-stenting? Ann R Coll Surg Engl 2011; 93: 31.

- Türk C, Neisius A, Petrik A, et al. Guidelines on Urolithiasis (EAU). 2018.

- Satava RM. Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol 2005; 14: 257-61.

- Dindo D, Demartines N, Clavien PA Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg (2004). 240:205–213.

-Kartal I, Çakıcı MÇ, Selmi V, Sarı S, Özdemir H, Ersoy H. Retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of stones in horseshoe kidney; what are the advantages and disadvantages compared to each other? Cent European J Urol. 2019;72(2):156-162. doi: 10.5173/ceju.2019.1906. Epub 2019 May 31. PMID: 31482022; PMCID: PMC6715073.

- Baylan B,Sari S,Cakici MC, et al. Is RIRS Safe and Efficient In Patients With Kidney Stones Who Had Previous Open, Endoscopic Percutaneous Kidney Stone Surgery? One Center Retrospective Study.Urol J.2019 Jun 22. doi: 10.22037/uj.v0i0.4950. [Epub ahead of print]

-Johnson GB, Grasso M. Exaggerated primary endoscope deflection: initial clinical experience with prototype flexible ureteroscopes. BJU Int 2004; 93: 109-14.

- Grasso M. Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am 2000; 27: 623-31.

- Razdan S, Johannes J, Cox M, et al. Current practice patterns in urologic management of upper-tract transitional-cell carcinoma. J Endourol 2005; 19: 366-71.

-Kızılay F, İrer B, Şen V, et al. 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. Journal of Urological Surgery, 2018;5(4):170-175

- Kroczak TJ, Kaler KS, Patel P, et al. Ureteroscopy with conscious sedation for distal ureteric calculi: 10-year experience. Can Urol Assoc J. 2016 Jan-Feb;10(1-2):E12-6.

- Zhu H, Xiao X, Chen X, et al. Ureteroscopic treatment of urological calculi under sacral block anesthesia. Urol Res. 2012 Aug;40(4):361-3.

- Miroglu C, Saporta L. Transurethral ureteroscopy: is local anesthesia with intravenous sedation sufficiently effective and safe? Eur Urol 1997;31:36-39.

- Shaikh AH, Khalid SE, Zaidi SZ. Ureteroscopy under spinal versus general anaesthesia: morbidity and stone clearance. J Coll Physicians Surg Pak. 2008 Mar;18(3):168-71.

- Park HK, Paick SH, Oh SJ, et al. Ureteroscopic lithotripsy under local anesthesia: analysis of the effectiveness and patient tolerability. Eur Urol 2004;45:670-673.

-Park HK, Choi EY, Jeong BC, et al. Localizations and expressions of alpha-1A, alpha-1B and alpha-1D adrenoceptors in human

ureter. Urol Res. 2007 Dec;35(6):325-9.

- Parikh DA, Patkar GA, Ganvir MS, et al. Is segmental epidural anaesthesia an optimal technique for patients undergoing percutaneous nephrolithotomy? Indian J Anaesth. 2017 Apr;61(4):308-314.

-Wuethrich PY, Kessler TM, Panicker JN, et al. Detrusor activity is impaired during thoracic epidural analgesia after open renal surgery. Anesthesiology. 2010;112:1345–9.

- Cheung MC, Lee F, Leung YL, et al. Outpatient ureteroscopy: predictive factors for postoperative events. Urology 2001; 58: 914-8.

- Schuster TG, Hollenbeck BK, Faerber GJ, et al. Complications of ureteroscopy: analysis of predictive factors. J Urol 2001; 166: 538-40.

-Tangpaitoon T, Nisoog C, Lojanapiwat B. Efficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural anesthesia with general anesthesia. Int Braz J Urol. 2012 Jul-Aug;38(4):504-11.

- Pu C, Wang J, Tang Y, et al. The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: A systematic review and meta‑analysis. Urolithiasis 2015;43:455‑66.

-Zeng G1, Zhao Z, Yang F,et al. Retrograde intrarenal surgery with combined spinal-epidural vs general anesthesia: a prospective randomized controlled trial. J Endourol. 2015 Apr;29(4):401-5.

- Singh V, Sinha RJ, Sankhwar SN, et al. A prospective randomized study comparing percutaneous nephrolithotomy under combined spinal-epidural anesthesia with percutaneous nephrolithotomy under general anesthesia. Urol Int 2011;87:293–298

DOI: http://dx.doi.org/10.22037/uj.v0i0.5638


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