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

Area of Science:

• Urology
• Anesthesiology
• Nephrology

Background:

• Prone percutaneous nephrolithotomy (PCNL) is typically done under general anesthesia (GA).
• Spinal anesthesia (SA) is emerging as a feasible alternative for PCNL.
• This study evaluates the safety and efficacy of prone PCNL under SA.

Purpose of the Study:

• To compare postoperative complications and stone-free rates (SFR) of prone PCNL under SA versus GA.
• To assess operative parameters and hospital stay for PCNL performed under SA.

Main Methods:

• A retrospective study of 778 patients undergoing prone PCNL by a single surgeon.
• Patients were divided into general anesthesia (GA) and spinal anesthesia (SA) groups.
• Propensity score matching (PSM) was used to compare outcomes between 280 patients in each group.

Main Results:

• No significant differences in stone characteristics or operative parameters like fluoroscopy time.
• Spinal anesthesia (SA) group showed significantly shorter surgery duration, anesthesia duration, and hospital stay.
• Comparable stone-free rates and overall postoperative complication rates between SA and GA groups, with no life-threatening complications.

Conclusions:

• Prone PCNL under spinal anesthesia (SA) is safe and effective.
• SA achieves comparable stone-free and complication rates to general anesthesia (GA).
• SA offers benefits of shorter operative time and hospital stay for PCNL.