Retrograd İntrarenal Cerrahi Yapılan Geriatrik Hastalarda Spinal ve Genel Anestezi Sonuçlarının Karşılaştırılması

Yıl 2025, Cilt: 17 Sayı: 3, 147 - 156, 30.09.2025

Demirhan Örsan Demir , Salih Bürlukkara , Turgay Kaçan , Ali Kaan Yıldız , Yusuf Gökkurt , Ömer Furkan Erbay , Tolga Karakan

https://doi.org/10.54233/endourolbull-1732746

Öz

Amaç: Bu çalışma 65 yaş üstü hastalarda spinal anestezinin (SA) retrograd intrarenal cerrahi’ de (RIRS) uygulanabilirliğini araştırmayı ve ayrıca spinal ve genel anestezi (GA) tekniklerinin postoperatif ağrı üzerine etkinliğini karşılaştırmayı amaçlamaktadır.
Gereç ve Yöntemler: RIRS uygulanan 281 hastanın retrospektif incelemesi yapıldı. Hastalar SA uygulanan (Grup 1) ve GA uygulananlar (Grup 2) olmak üzere 2 gruba ayrıldı. Grupların perioperatif ve postoperatif RIRS sonuçları ve komplikasyon oranları karşılaştırıldı. Ayrıca Vizüel Analog Scale (VAS) kullanılarak postoperatif erken ve geç dönem ağrı düzeyleri karşılaştırıldı.
Bulgular: SA uygulanan Grup 1 166 hastadan, GA uygulanan Grup 2 115 hastadan oluşuyordu. Grupların demografik verileri ve taş özellikleri benzer olarak bulundu. Her 2 anestezi tekniğinde modifiye Clavien-Dindo komplikasyon oranları benzerdi. Gruplar arasında operasyon süresi (p = 0,344) ve hastanede yatış süresi (p = 0,876) açısından fark gözlenmedi. Grup 1’ de erken dönem ortalama VAS skoru 2,26 ± 0,99 iken Grup 2’ de 3,58 ± 1,13 olarak bulundu ve aradaki fark istatistiksel olarak anlamlıydı (p < 0,001). Geç dönem VAS skorları arasında istatistiksel anlamlı fark gözlenmedi (p = 0,362). Grup 1’ deki hastaların %10,24’ ünde postoperatif analjezi ihtiyacı olurken, Grup 2’ deki hastaların %27,82 ‘sinin postoperatif analjezi ihtiyacı olmuştur ve aradaki fark istatistiksel olarak anlamlıydı (p < 0,001).
Sonuç: Spinal anestezi postoperatif ağrı kontrolünde olumlu sonuçlar vermesi ve hastaları genel anestezinin olası bazı morbidetelerinden koruması nedeniyle RIRS yapılacak geriatrik hastalarda genel anesteziye alternatif bir teknik olabilir.

Anahtar Kelimeler

genel anestezi , postoperatif ağrı , rejyonel anestezi , spinal anestezi

Etik Beyan

Karabük Üniversitesi Klinik Araştırma Etik Kurulu tarafından onaylanmıştır. Tarih: 1/4/2024 Karar No: 2024/1718.

Destekleyen Kurum

Bu araştırma ile ilgili özel bir finansman yoktur.

Comparison of Spinal and General Anesthesia Outcomes in Geriatric Patients Undergoing Retrograde Intrarenal Surgery

Öz

Objective: This study aims to investigate the feasibility of spinal anesthesia (SA) in retrograde intrarenal surgery (RIRS) among patients aged over 65 years, and to compare the effectiveness of spinal and general anesthesia (GA) techniques on postoperative pain.
Material and Methods: A retrospective analysis was conducted on 281 patients who underwent RIRS. Patients were divided into two groups: those who received SA (Group 1) and those who received GA (Group 2). Perioperative and postoperative outcomes of RIRS were compared between the groups. Additionally, postoperative pain levels in both the early and late periods were assessed using the Visual Analog Scale (VAS).
Results: Group 1, which received SA, consisted of 166 patients, while Group 2, which received GA, included 115 patients. There was no statistically significant difference between the two groups in the demographic data and stone characteristics. The complication rates, classified according to the modified Clavien-Dindo system, were comparable between the two anesthesia techniques. The mean early postoperative VAS score was 2.26 ± 0.99 in Group 1 and 3.58 ± 1.13 in Group 2, with the difference being statistically significant (p < 0.001). However, there was no statistically significant difference in late postoperative VAS scores between the groups (p = 0.362). Postoperative analgesic requirement was observed in 10.24% of patients in Group 1, compared to 27.82% in Group 2, and this difference was statistically significant (p < 0.001).
Conclusion: SA may be a viable alternative to GA in geriatric patients undergoing RIRS, as it provides favorable outcomes in postoperative pain control and may protect patients from certain potential morbidities associated with GA.

Anahtar Kelimeler

general anesthesia , post operative pain , regional anesthesia , spinal anesthesia

Etik Beyan

Approved by the Karabük University Clinical Research Ethics Committee. Date: 1/4/2024 Decision No: 2024/1718.

Destekleyen Kurum

There is no specific funding related to this research.

Kaynakça

• 1. Patel V, Raghuvanshi K, Chaudhari R. Evaluating temperature dynamics: a single-center prospective randomized pilot study of holmium versus thulium laser fiber for renal stones. World J Urol. 2025 Jan 28;43(1):91. https://doi. org/10.1007/s00345-025-05466-y
• 2. Rule AD, Lieske JC, Li X, Melton LJ 3rd, Krambeck AE, Bergstralh EJ. The ROKS nomogram for predicting a second symptomatic stone episode. J Am Soc Nephrol. 2014;25(12):2878-86. https://doi.org/10.1681/ASN.2013091011
• 3. Li ML, Song SC, Yang F, Gao C, Zhou B, Wang Q. Risk assessment and prevention of urolithiasis in urban areas of Baoding, China. Medicine (Baltimore). 2024 Jan 12;103(2):e35880. https://doi.org/10.1097/MD.0000000000035880
• 4. Knoll T, Schubert AB, Fahlenkamp D, Leusmann DB, Wendt-Nordahl G, Schubert G. Urolithiasis through the ages: data on more than 200,000 urinary stone analyses. J Urol. 2011;185(4):1304-11. https://doi.org/10.1016/j.juro.2010.11.073
• 5. Akram M, Jahrreiss V, Skolarikos A, Geraghty R, Tzelves L, Emilliani E, Davis NF, Somani BK. Urological Guidelines for Kidney Stones: Overview and Comprehensive Update. J Clin Med. 2024 Feb 16;13(4):1114. https://doi.org/10.3390/ jcm13041114
• 6. Bosio A, Dalmasso E, Alessandria E, Agosti S, Pizzuto G, Peretti D, Palazzetti A, Bisconti A, Destefanis P, Fop F, Gontero P. Retrograde intra-renal surgery under spinal anesthesia: the first large series. Minerva Urol Nefrol. 2018 Jun;70(3):333-9. https://doi.org/10.23736/S0393-2249.18.02926-07.
• 7. Aykac A, Baran O. Safety and efficacy of retrograde intrarenal surgery in geriatric patients by age groups. Int Urol Nephrol. 2020 Dec;52(12):2229-36. https://doi.org/10.1007/s11255-020-02564-1
• 8. United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2019: Highlights (ST/ESA/SER.A/430). 2019. Available from: https://www.un.org/en/development/desa/population/ publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf
• 9. Chung JW, Kang JK, Jung W, Oh KJ, Kim HW, Shin DG, Kim BS. The Efficacy and Safety of Radiation-Free Retrograde Intrarenal Surgery: A Prospective Multicenter-Based, Randomized, Controlled Trial. J Urol. 2024 Jun;211(6):735-42. https://doi.org/10.1097/JU.0000000000003920
• 10. Hosokawa R, Ojima T, Myojin T, Kondo K, Kondo N. Geriatric symptoms associated with healthy life expectancy in older people in Japan. Environ Health Prev Med. 2023;28:44. https://doi.org/10.1265/ehpm.22-00300
• 11. Mager R, Brauers C, Kurosch M, Dotzauer R, Borgmann H, Haferkamp A. Outcomes for Geriatric Urolithiasis Patients aged ≥80 Years Compared to Patients in Their Seventies. Eur Urol Focus. 2022 Jul;8(4):1103-9. https://doi. org/10.1016/j.euf.2021.08.004
• 12. Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF; American College of Surgeons NSQIP; American Geriatrics Society. Optimal preoperative assessment of the geriatric surgical patient: best practices guideline. J Am Coll Surg. 2012 Oct;215(4):453-66. https://doi.org/10.1016/j.jamcollsurg.2012.06.017
• 13. Chatterji S, Byles J, Cutler D, Seeman T, Verdes E. Health, functioning, and disability in older adults—present status and future implications. Lancet. 2015 Feb 7;385(9967):563-75. https://doi.org/10.1016/S0140-6736(14)61462-8
• 14. Wang W, Gao X, Ma Y, Di X, Xiao K, Zhou L, et al. Regional vs General Anesthesia for Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis. J Endourol. 2020 Nov;34(11):1121-8. https://doi.org/10.1089/end.2020.0188
• 15. Oguz U, Resorlu B, Ozyuvali E, Bozkurt OF, Senocak C, Unsal A. Categorizing intraoperative complications of retrograde intrarenal surgery. Urol Int. 2014;92(2):164-8. https://doi.org/10.1159/000354623
• 16. Çanakcı C, Dinçer E, Can U, Coşkun A, Otbasan BK, Özkaptan O. The relationship between stone-free and patient position in retrograde intrarenal surgery: a randomized prospective study. World J Urol. 2024 May 9;42(1):308. https://doi.org/10.1007/s00345-024-05013-1
• 17. Bai J, Shangguan T, Zou G, Liu L, Xue X, Lin J, et al. Efficacy and intrarenal pressure analysis of flexible and navigable suction ureteral access sheaths in modified surgical positions: a multicenter retrospective study. Front Med (Lausanne). 2024 Nov 20;11:1501464. https://doi.org/10.3389/fmed.2024.1501464
• 18. Berardinelli F, De Francesco P, Marchioni M, Cera N, Proietti S, Hennessey D, et al. RIRS in the elderly: is it feasible and safe? Int J Surg. 2017;42:147-51. https://doi.org/10.1016/j.ijsu.2017.04.038
• 19. Owen AR, Amundson AW, Larson DR, Duncan CM, Smith HM, Johnson RL, et al. Spinal Versus General Anesthesia in Contemporary Revision Total Knee Arthroplasties. J Arthroplasty. 2023 Jun;38(6S):S271-S274.e1. https://doi. org/10.1016/j.arth.2023.01.053
• 20. Breda A, Angerri O. Retrograde intrarenal surgery for kidney stones larger than 2.5 cm. Curr Opin Urol. 2014;24(2):179-83. https://doi.org/10.1097/MOU.0000000000000034
• 21. Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem Pharmacol. 2020 Oct;180:114147. https://doi.org/10.1016/j.bcp.2020.114147
• 22. Çakici MÇ, Özok HU, Erol D, Çatalca S, Sari S, Özdemir H, et al. Comparison of general anesthesia and combined spinal-epidural anesthesia for retrograde intrarenal surgery. Minerva Urol Nefrol. 2019 Dec;71(6):636-43. https:// doi.org/10.23736/S0393-2249.19.03481-7
• 23. Morgan L, McKeever TM, Nightingale J, Deakin DE, Moppett IK. Spinal or general anaesthesia for surgical repair of hip fracture: risk of mortality and morbidity. Anaesthesia. 2020 Sep;75(9):1173-9. https://doi.org/10.1111/ anae.15042
• 24. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: overview of randomised trials. BMJ. 2000 Dec 16;321(7275):1493. https://doi.org/10.1136/bmj.321.7275.1493
• 25. 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 Apr;29(4):401-5. https://doi. org/10.1089/end.2014.0249
• 26. Kılınç MT, Özkent MS, Çavdar ÖF, Güneş B, Erol A, Pişkin MM. Does tidal volume during mechanical ventilation affect pediatric retrograde intrarenal surgery outcomes? World J Urol. 2025 Feb 4;43(1):103. https://doi.org/10.1007/ s00345-025-05480-0
• 27. Lim EJ, Somani BK, Gokce MI, Heng CT, Satapathy AR, Robles JI, et al. General anaesthesia with gated or controlled mechanical ventilation in retrograde intrarenal surgery: a prospective study. World J Urol. 2025 Feb 8;43(1):110. https://doi.org/10.1007/s00345-025-05488-6