Flexible ureteroscopy (fURS) has become a cornerstone in the management of ureteral and renal stones, offering high efficacy with minimal invasiveness. Traditionally performed under general anesthesia (GA), the feasibility of     spinal anesthesia (SA)     in fURS remains underexplored. This study evaluates     the advantages, challenges, and outcomes of performing flexible ureteroscopy under spinal anesthesia     in a cohort of     70 patients    , emphasizing the potential benefits of     synchronous respiratory movement and laser fiber control     for enhanced stone dusting efficiency.

A prospective analysis of     70 patients     undergoing flexible ureteroscopy with     holmium:YAG laser lithotripsy under spinal anesthesia     was conducted. Parameters analyzed included     surgical time, stone-free rate, patient tolerance, intraoperative challenges, and postoperative complications    . Special attention was given to     respiration-induced stone movement     and its potential advantages in     coordinating laser fiber application with stone motion     to optimize     dusting efficiency    .

Results:      
-     Stone-free rate (SFR):         85.7% at 1 month postoperatively    .  
-     Mean operative time:         51.2 ± 8.6 minutes    .  
-     Patient Tolerance:         96% of patients tolerated the procedure well    , with     no conversions to GA    .  
-     Intraoperative Advantages:     The     rhythmic movement of the stone with respiration     under SA allowed     experienced surgeons to synchronize laser application    , improving     stone dusting efficiency and reducing laser time    .  
-     Complications:     Minor complications (    Clavien-Dindo Grade I-II    ) were observed in     10% of cases    , with     no major complications     requiring intervention.

Results:      
-     Stone-free rate (SFR):         85.7% at 1 month postoperatively    .  
-     Mean operative time:         51.2 ± 8.6 minutes    .  
-     Patient Tolerance:         96% of patients tolerated the procedure well    , with     no conversions to GA    .  
-     Intraoperative Advantages:     The     rhythmic movement of the stone with respiration     under SA allowed     experienced surgeons to synchronize laser application    , improving     stone dusting efficiency and reducing laser time    .  
-     Complications:     Minor complications (    Clavien-Dindo Grade I-II    ) were observed in     10% of cases    , with     no major complications     requiring intervention.

Spinal anesthesia in fURS is     safe, effective, and well-tolerated    , with     respiratory-induced stone movement     providing an unexpected advantage in     precise laser fiber positioning     for efficient stone dusting. This technique may offer a viable alternative to general anesthesia, particularly in select patient populations.     Further studies comparing SA and GA for fURS are warranted to validate these findings.

Türk, C., et al. (2021). European Association of Urology Guidelines on Urolithiasis.   European Urology
Aboumarzouk, O. M., et al. (2012). Flexible ureteroscopy and laser lithotripsy for stone disease: A systematic review and meta-analysis.   Journal of Endourology  .
Patel, S. R., et al. (2017). Outcomes of ureteroscopy under spinal versus general anesthesia.   Urology  .