Comparing local versus spinal anesthesia for transurethral cystolithotripsy: A retrospective review of efficacy, safety, and pain outcomes

INTRODUCTION: Urinary bladder stones cause significant morbidity and are increasingly treated by transurethral holmium laser cystolithotripsy (TULC), a minimally invasive procedure. While spinal anesthesia is commonly used, local anesthesia is gaining interest, especially for high-risk or elderly patients. This study compares the safety, efficacy, and outcomes of TULC under local versus spinal anesthesia. METHODS: A retrospective observational study at AIIMS, Jodhpur, India (March 2023-March 2025) included 81 bladder stone patients undergoing TULC. 43 received local anesthesia and 38 spinal anesthesia. Data on demographics, stone size and number, operative time, pain scores (Visual Analogue Scale), complications, and stone clearance were analyzed. RESULTS: Both groups were comparable in age and sex. Mean stone size was smaller in the local anesthesia group (22 mm) compared to spinal anesthesia (30 mm); multiple stones were more common with spinal (26.3% vs 9.3%). Complete stone clearance was achieved in all patients. Operative time was shorter under local anesthesia (45.3 vs 55 min). Pain scores were similar (VAS 3.69 vs 3.70). Minor complications, such as hematuria and fever, occurred but resolved conservatively. No major complications or mortality were reported. Patient satisfaction was slightly lower with local anesthesia (Likert 4.05 vs 4.13). CONCLUSIONS: Holmium laser cystolithotripsy is safe and effective under both local and spinal anesthesia. Local anesthesia is a well-tolerated alternative for smaller stones, offering a quicker procedure with similar pain outcomes. Spinal anesthesia remains preferred for larger or multiple stones. Further randomized studies are needed to optimize anesthesia selection criteria.