Anesthesia Requirements for Management of Bilateral Renal Calculi with Bilateral Hydronephrosis
Yes, anesthesia is required for the management of bilateral renal calculi with bilateral hydronephrosis due to ureteric calculi, with the specific type depending on the chosen procedure. 1
Anesthesia Requirements Based on Treatment Approach
The type of anesthesia needed depends on the selected treatment modality:
For Ureteroscopy (URS)
- General anesthesia is typically required for bilateral ureteroscopic procedures, especially when dealing with bilateral hydronephrosis which indicates a more complex clinical situation 2
- While URS can be performed under intravenous sedation in some cases, bilateral procedures generally require general anesthesia for:
For Percutaneous Nephrolithotomy (PCNL)
- General anesthesia is the standard for PCNL, particularly for bilateral cases 4
- PCNL is often the preferred approach for bilateral renal calculi causing hydronephrosis due to its higher stone-free rates (90% after second PCNL) compared to other modalities 2
- While historical data shows intravenous-assisted local anesthesia was used in some PCNL cases (94% in older studies), current practice favors general anesthesia for bilateral procedures 5
For Shock Wave Lithotripsy (SWL)
- Intravenous sedation or minimal anesthetic techniques are usually sufficient 2
- SWL offers the advantage of being performed with less intensive anesthesia compared to URS or PCNL 2
- However, SWL has lower success rates for complex stones and may not be optimal for bilateral hydronephrosis cases 2
Anesthetic Agents and Considerations
- For general anesthesia, remifentanil may be used at 0.5-1 mcg/kg/min for induction, followed by 0.05-2 mcg/kg/min for maintenance, in combination with other anesthetic agents 6
- For less invasive procedures like distal ureteral stones <1cm, regional anesthesia such as sacral block with 2% lidocaine has shown success rates of 97.8% 7
Special Considerations for Bilateral Hydronephrosis
- Urgent intervention is required to prevent renal damage and potential renal failure 1
- For patients with signs of infection and obstruction, initial decompression under anesthesia should be performed before definitive stone removal 1
- Synchronous bilateral PCNL (both sides treated under the same anesthesia) may be considered for select patients, reducing total anesthesia exposure compared to staged procedures 4
Factors Influencing Anesthesia Choice
- Stone location and size
- Patient comorbidities
- Presence of infection
- Expected procedure duration
- Surgeon experience and preference
Conclusion
Anesthesia is mandatory for managing bilateral renal calculi with hydronephrosis. While some procedures like SWL can be performed under minimal anesthesia, the bilateral nature and complexity of hydronephrosis typically necessitate general anesthesia for optimal outcomes and patient comfort, particularly when ureteroscopy or PCNL are the chosen treatment modalities.