Introduction: This study aimed to compare spinal and general anesthesia methods in endoscopic management of proximal ureteral stones with a particular emphasis on total anesthesia time. Methods: A total of 246 adult patients undergoing ureteroscopic management for proximal ureteral stones between January 2021 and March 2023 were enrolled. Two different types of anesthesia, namely, spinal (group 1, n = 109) and general (group 2, n = 137) anesthesia, were applied during these procedures. Results: The mean total anesthesia time of group 1 was statistically significantly shorter than that of group 2 (61.4 ± 28.7 and 93.7 ± 29.2 min, respectively, p = 0.013). While 92.7% of patients in group 1 were stone free after the interventions, this value was 92% in group 2 (p = 0.828). There was no statistically significant difference between the two groups regarding peri- (p = 0.126) or postoperative (p = 0.284) complications. Conclusions: Our results demonstrated well that both spinal and general anesthesia methods could be applied in a successful and safe manner in the endoscopic management of proximal ureteral stones. However, a shorter total anesthesia time under spinal anesthesia could be anticipated during endoscopic management of proximal ureteral stones.

1.
Sancak
EB
,
Kılınç
MF
,
Yücebaş
SC
.
Evaluation with decision trees of efficacy and safety of semirigid ureteroscopy in the treatment of proximal ureteral calculi
.
Urol Int
.
2017
;
99
(
3
):
320
5
.
2.
Reis Santos
JM
.
Ureteroscopy from the recent past to the near future
.
Urolithiasis
.
2018
;
46
(
1
):
31
7
.
3.
Skolarikos
A
,
Jung
HU
,
Neisius
A
,
Petrik
A
,
Tailly
T
,
Thomas
K
, et al
.
EAU guidelines on urolithiasis. European association of Urology
.
Arnhem, The Netherlands
:
EAU Guidelines Office
;
2023
.
4.
Yildirim
D
,
Hut
A
,
Uzman
S
,
Kocakusak
A
,
Demiryas
S
,
Cakir
M
, et al
.
Spinal anesthesia is safe in laparoscopic total extraperitoneal inguinal hernia repair. A retrospective clinical trial
.
Videosurg Other Miniinvasive Tech
.
2017
;
12
(
4
):
417
27
.
5.
Havas
F
,
Orhan Sungur
M
,
Yenigün
Y
,
Karadeniz
M
,
Kilic
M
,
Özkan Seyhan
T
.
Spinal anesthesia for elective cesarean section is associated with shorter hospital stay compared to general anesthesia
.
Agri
.
2013
;
25
(
2
):
55
63
.
6.
Shaikh
AH
,
Khalid
SE
,
Zaidi
SZ
.
Ureteroscopy under spinal versus general anaesthesia: morbidity and stone clearance
.
J Coll Physicians Surg Pak
.
2008
;
18
(
3
):
168
71
.
7.
Mehrabi
S
,
Karimzadeh Shirazi
K
.
Results and complications of spinal anesthesia in percutaneous nephrolithotomy
.
Urol J
.
2010
;
7
(
1
):
22
5
.
8.
Jain
R
,
Omar
M
,
Chaparala
H
,
Kahn
A
,
Li
J
,
Kahn
L
, et al
.
How accurate are we in estimating true stone volume? A comparison of water displacement, ellipsoid formula, and a CT-based software tool
.
J Endourol
.
2018
;
32
:
572
6
.
9.
Koras
O
,
Bozkurt
IH
,
Karakoyunlu
AN
,
Celik
S
,
Sefik
E
,
Yarimoglu
S
, et al
.
Retrospective analysis of the factors affecting intraoperative and immediate postoperative complications of retrograde intrarenal surgery classified by the Clavien and Satava Grading Systems
.
J Endourol
.
2021
;
35
(
12
):
1764
72
.
10.
Demirdag
C
,
Citgez
S
,
Obek
C
.
Clavien system classification of complications developed following laparoscopic urological operations applied in our clinic
.
Sisli Etfal Hastan Tip Bul
.
2019
;
53
(
3
):
228
39
.
11.
Iremashvili
V
,
Li
S
,
Penniston
KL
,
Best
SL
,
Hedican
SP
,
Nakada
SY
.
Role of residual fragments on the risk of repeat surgery after flexible ureteroscopy and laser lithotripsy: single center study
.
J Urol
.
2019
;
201
(
2
):
358
63
.
12.
Kallidonis
P
,
Ntasiotis
P
,
Knoll
T
,
Sarica
K
,
Papatsoris
A
,
Somani
BK
, et al
.
Minimally invasive surgical ureterolithotomy versus ureteroscopic lithotripsy for large ureteric stones: a systematic review and meta-analysis of the literature
.
Eur Urol Focus
.
2017
;
3
(
6
):
554
66
.
13.
Khalil
,
M
.
Management of impacted proximal ureteral stone: extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy
.
Urol Ann
.
2013
;
5
(
2
):
88
92
.
14.
Tefik
T
,
Guven
S
,
Villa
L
,
Gokce
MI
,
Kallidonis
P
,
Petkova
K
, et al
.
Urolithiasis practice patterns following the COVID-19 pandemic: overview from the EULIS collaborative research working group
.
Eur Urol
.
2020
;
78
(
1
):
e21
4
.
15.
Sarakatsianou
C
,
Georgopoulou
S
,
Baloyiannis
I
,
Chatzimichail
M
,
Vretzakis
G
,
Zacharoulis
D
, et al
.
Spinal versus general anesthesia for transabdominal preperitoneal (TAPP) repair of inguinal hernia: interim analysis of a controlled randomized trial
.
Am J Surg
.
2017
;
214
(
2
):
239
45
.
16.
Tzovaras
G
,
Fafoulakis
F
,
Pratsas
K
,
Georgopoulou
S
,
Stamatiou
G
,
Hatzitheofilou
C
.
Spinal vs general anesthesia for laparoscopic cholecystectomy: interim analysis of a controlled randomized trial
.
Arch Surg
.
2008
;
143
(
5
):
497
501
.
17.
Nouralizadeh
A
,
Ziaee
SAM
,
Hosseini Sharifi
SH
,
Basiri
A
,
Tabibi
A
,
Sharifiaghdas
F
, et al
.
Comparison of percutaneous nephrolithotomy under spinal versus general anesthesia: a randomized clinical trial
.
J Endourol
.
2013
;
27
(
8
):
974
8
.
18.
Moawad
HES
,
El Hefnawy
AS
.
Spinal vs. general anesthesia for percutaneous nephrolithotomy: a prospective randomized trial
.
Egypt J Anaesth
.
2015
;
31
(
1
):
71
5
.
19.
Kwon
O
,
Lee
JM
,
Park
J
,
Cho
MC
,
Son
H
,
Jeong
H
, et al
.
Influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal stone surgery: a prospective, randomized controlled study
.
BMC Anesthesiol
.
2019
;
19
:
239
8
.
20.
Pierce
JT
,
Kositratna
G
,
Attiah
MA
,
Kallan
MJ
,
Koenigsberg
R
,
Syre
P
, et al
.
Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients
.
Local Reg Anesth
.
2017
;
10
:
91
8
.
21.
Pu
X
,
Sun
JM
.
General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty: a meta-analysis
.
Medicine
.
2019
;
98
(
16
):
e14925
.
22.
Zeng
G
,
Zhao
Z
,
Yang
F
,
Zhong
W
,
Wu
W
,
Chen
W
.
Retrograde intrarenal surgery with combined spinal-epidural vs general anesthesia: a prospective randomized controlled trial
.
J Endourol
.
2015
;
29
(
4
):
401
5
.
23.
Wang
P
,
Zhan
Y
,
Li
J
,
Liu
G
,
Li
Z
,
Bai
S
.
Comparison of shock wave lithotripsy and ureteroscopy in patients with proximal ureteral stones under the COVID-19 pandemic
.
World J Urol
.
2023
;
41
(
3
):
797
803
.
24.
Lazarovich
A
,
Haramaty
R
,
Shvero
A
,
Zilberman
DE
,
Dotan
ZA
,
Winkler
H
, et al
.
Primary ureteroscopy without pre-stenting for proximal ureteral stones—is it feasible
.
Life
.
2023
;
13
(
10
):
2019
.
25.
Yazici
CM
,
Siddikoglu
D
,
Cinar
O
,
Ozman
O
,
Basatac
C
,
Akgul
M
, et al
.
Does extracorporeal shock wave lithotripsy before retrograde intrarenal surgery complicates the surgery for upper ureter stone? The results of the RIRSearch group
.
Int J Clin Pract
.
2021
;
75
(
5
):
e14115
.
26.
Ozman
O
,
Akgul
HM
,
Basatac
C
,
Çınar
Ö
,
Sancak
EB
,
Yazici
CM
, et al
.
Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: a RIRSearch group study
.
Asian J Urol
.
2024
;
11
(
1
):
80
5
.
27.
Elashry
OM
,
Elgamasy
AK
,
Sabaa
MA
,
Abo-Elenien
M
,
Omar
MA
,
Eltatawy
HH
, et al
.
Ureteroscopic management of lower ureteric calculi: a 15-year single-centre experience
.
BJU Int
.
2008
;
102
(
8
):
1010
7
.
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