Ureteroscopic Manipulation for Ureteral Calculi: Comparison between Local and Spinal Anesthesia

Park, Hi Cheol

Abstract

Ureteroscopic removal of urethral calculi is an established treatment nowadays and can be performed under direct vision using flexible grasping forceps, stone baskets, electrohydraulic lithotriptor with increased safety and efficacy. In this study we tried to analyse the exact role of ureteroscopic manipulation between spinal and local anesthesia. In 127 ureteroscopic stone removal procedures performed from May 1994 to December 1996, under local anesthesia (55 case) and spinal anesthesia (72 case), the success rate and complications were measured. The sucess was defined to complete removal of stone or residual stone less than 1 mm. The success rate of the ureteroscopic manipulation was 80.3% (102/127), 81.9% (59/72), 78.4% (43/55) in total, spinal and local anesthesia, respectively. The success rate of the ureteroscopic manipulation was 75% (3/4), 71.4% (5/7), 83.6% (51/61) in upper, middle and lower ureter stones, under spinal anesthesia and 64.3% (9/14), 66.7% (6/9), 87.5% (28/32) under local anesthesia. According to the size of the stone, the success rate was 89.7% (35/39), 68.2% (15/22), 81.8% (9/)1) under spinal anesthesia when it was less than 5mm, 6 to 10 mm, and larger than 10 mm, 86.7% (26/30), 68.2% (Is/22), 66.7% (2/3) under local anesthesia. Complication was found in 16.6% of cases of the spinal anesthetic procedures and it was 21.8% of those of the local anesthetic procedures. These observations showed that ureteroscopic removal of ureteral calculi, when performed without spinal anesthesia, does not increase the risk of complications or compromise the results of treatment.