Comparing Spinal and General Anesthesia for Prone Percutaneous Nephrolithotomy: A Propensity Score-Matched Study

Prone percutaneous nephrolithotomy (PCNL) is commonly performed under general anesthesia (GA); however, increasing evidence supports the feasibility of PCNL under spinal anesthesia (SA). This study presents our experience with prone PCNL under SA performed by a single surgeon. The primary outcome was the incidence of postoperative complications according to the modified Clavien-Dindo classification, and the secondary outcome was the stone-free rate (SFR).

A total of 778 patients who underwent PCNL for kidney stones by a single surgeon between June 2014 and May 2023 were divided into two groups: Group GA (n=498) and Group SA (n=280). Demographic and stone characteristics, operative parameters, SFR, and complications were compared between the groups after 1:1 propensity score matching (PSM) based on age, sex, and stone burden.

After PSM, 280 patients in Group SA were matched with 280 patients in Group GA. No significant differences were observed between the groups in terms of stone number, side, or localization. The use of intercostal access, need for multiple access tracts, and fluoroscopy time were also comparable. However, surgery duration, anesthesia duration, and hospital stay were significantly shorter in Group SA (p<0.001, p=0.04, and p<0.001, respectively). The SFR at the first evaluation and after auxiliary treatments was similar between groups. Overall postoperative complication rates did not differ significantly, and no life-threatening (Clavien-Dindo grade IV-V) complications occurred.

Compared with GA, prone PCNL can be performed safely and effectively under SA, achieving comparable stone-free and complication rates while offering shorter operative time and hospital stay.