Comparison of Regional and General Anesthesia in Ureterorenoscopic Management of Distal Ureteral Stones: A Prospective Randomized Study

Objective: To compare the effects of regional (spinal) and general anesthesia (GA) on surgical outcomes, perioperative complications, postoperative pain, and surgeon comfort in patients undergoing ureterorenoscopy (URS) for distal ureteral stones. Method: This prospective, randomized clinical study included patients undergoing URS for distal ureteral calculi at a tertiary academic center between January 2024 and March 2025. Patients were allocated to either the GA or regional anesthesia (RA) group. Baseline demographics, operative parameters, postoperative pain scores [visual analogue scale (VAS)], analgesic requirements, and surgeon comfort were recorded and statistically compared. Results: A total of 180 patients were included (90 in each group). Demographic and stone characteristics were similar between the two groups. The mean operative time was significantly shorter in the GA group (22.9±8.3 vs. 27.9±9.5 min, p=0.001). VAS were significantly lower in the GA group at the 6th and 12th hours: median VAS scores were 5.0 [interquartile range (IQR) 4.0-6.0] vs. 6.0 (IQR 5.0-6.3) at 6 hours (p=0.001), and 4.0 (IQR 3.0-5.0) vs. 6.0 (IQR 4.0-6.8) at 12 hours (p=0.001), respectively. Surgeon comfort scores were also significantly higher in the GA group (p=0.001). Success and complication rates did not differ significantly between groups. Conclusion: Both general and RA are safe and effective for URS in distal ureteral stone management. However, GA is associated with shorter operative times, reduced postoperative pain in the early period, and improved surgeon comfort. These findings suggest that anesthetic modality may influence both clinical and surgical aspects of endourological procedures.