Spinal versus general anesthesia during retrograde intra-renal surgery: A propensity score matching analysis

The indications for retrograde intra-renal surgery (RIRS) have greatly increased, however, there is still no consensus on the use of spinal anesthesia (SA) during this procedure. The aim of this study was to evaluate the comparability of surgical conditions and outcomes with RIRS performed under SA versus general anesthesia (GA) for renal stones.

This was a prospective, observational study in patients scheduled for RIRS in a single teaching hospital in Italy. Inclusion criteria were age >18 years and the presence of single or multiple renal stones. We recorded information concerning the site of lithiasis, the number of calculi, total stone burden, and the presence of concomitant ureteral stones or hydronephrosis. A propensity score-matched analysis was performed to evaluate the results in terms of surgical outcome, intraoperative and postoperative complications, and analgesia demand balanced for confounding factors. Patients were followed-up until day 90 from discharge.

We included 120 patients, the propensity score-matched cohort included 40 patients in the SA and 40 in the GA groups. The stone-free rate was 67.5% in the GA group and 70.0% in the SA group (p = 0.81). The use of auxiliary procedures within 90 days did not differ between groups (25.0% vs. 22.5%, p = 0.79). No cases of conversion from SA to GA were recorded. We did not find any differences in intraoperative bleedings, perforations, and abortions. Complication rates were similar in the 2 groups (10.0% in GA vs. 5.0% in SA, p = 0.64).

In our cohort, RIRS performed under SA and GA was equivalent in terms of surgical results and complications.