Olivero Alberto, Ball Lorenzo, Fontaneto Carlotta, Mantica Guglielmo, Bottino Paolo, Pelosi Paolo, Terrone Carlo
Department of Surgical and Integrated Diagnostics, University of Genova, Genova, Italy.
Division of Urology, Ospedale Policlinico San Martino IRCCS for Oncology and Neurosciences, Genova, Italy.
Curr Urol. 2021 Jun;15(2):106-110. doi: 10.1097/CU9.0000000000000014. Epub 2021 Apr 26.
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 ( = 0.81). The use of auxiliary procedures within 90 days did not differ between groups (25.0% vs. 22.5%, = 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, = 0.64).
In our cohort, RIRS performed under SA and GA was equivalent in terms of surgical results and complications.
逆行性肾内手术（RIRS）的适应证已大幅增加，然而，在此手术过程中使用脊髓麻醉（SA）仍未达成共识。本研究的目的是评估在SA与全身麻醉（GA）下进行RIRS治疗肾结石时手术条件和结果的可比性。
这是一项在意大利一家教学医院对计划进行RIRS的患者进行的前瞻性观察性研究。纳入标准为年龄>18岁且存在单个或多个肾结石。我们记录了有关结石部位、结石数量、结石总负荷以及是否存在输尿管结石或肾积水的信息。进行倾向评分匹配分析，以评估手术结果、术中及术后并发症以及镇痛需求方面的结果，并平衡混杂因素。对患者进行随访直至出院后90天。
我们纳入了120例患者，倾向评分匹配队列包括SA组40例患者和GA组40例患者。GA组的无结石率为67.5%，SA组为70.0%（P = 0.81）。两组在90天内使用辅助程序的情况无差异（25.0%对22.5%，P = 0.79）。未记录到从SA转换为GA的病例。我们未发现术中出血、穿孔和流产方面的任何差异。两组的并发症发生率相似（GA组为10.0%，SA组为5.0%，P = 0.64）。
在我们的队列中，在SA和GA下进行的RIRS在手术结果和并发症方面相当。
