Endoscopic Combined Intrarenal Surgery Versus Percutaneous Nephrolithotomy for Complex Renal Stones: A Systematic Review and Meta-Analysis

Liu, Yung-Hao; Jhou, Hong-Jie; Chou, Meng-Han; Wu, Sheng‐Tang; Cha, Tai‐Lung; Yü, Dah‐Shyong; Sun, Guang‐Huan; Chen, Po-Huang; Meng, En

doi:10.3390/jpm12040532

Cited by 18 publications

(15 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to the obtained data, in the ECIRS groups compared to PNL in mono-mode, there was a better result of primary and final SFR, fewer complications and the need for blood transfusion. In the analysis of these methods in the «mini-version», there was an additional reduction in the length of hospital stay in the group of mini-ECIRS in comparison with the mini-PNL in mono-mode [42].…”

Section: Resultsmentioning

confidence: 99%

“…Secondly, the problem of high cost of ECIRS, mentioned in the study of H. D. Jung et al, where the authors pointed out the difficulties in calculating the cost of these procedures, which can be problematic for the hospital [17]. Thirdly, when combining the two procedures, the surgery duration of ECIRS is sometimes considered longer, but a number of studies have not found a significant difference in the surgery duration between ECIRS and PNL [35,42].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The use of endoscopic combined intrarenal surgery in the treatment of nephrolithiasis

Postol

Sahalevych²,

Serhiichuk³

et al. 2022

ZMJ

View full text Add to dashboard Cite

Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment. Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods. Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety. Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy. Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The use of endoscopic combined intrarenal surgery in the treatment of nephrolithiasis

Postol

Sahalevych²,

Serhiichuk³

et al. 2022

ZMJ

View full text Add to dashboard Cite

show abstract

“…The authors conclude that this novel technique brings better stone free rates and fewer complications and requires less blood transfusions compared to PCNL alone. The devices used for lithotripsy are not compared and no comment is made in this direction [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Single-Center Experience with Swiss LithoClast® Trilogy for Kidney Stones

et al. 2023

View full text Add to dashboard Cite

Introduction: PCNL remains the gold standard for larger kidney stones. Reducing the operating time of PCNL and its complication rate seems to be the next logical step in optimizing this classical technique. To achieve these objectives, some new methods of lithotripsy emerge. We present the data of a single, high-volume, academic center with combined ultrasonic and ballistic lithotripsy in PCNL using the Swiss LithoClast® Trilogy device. Materials and Methods: We designed a prospective, randomized study including patients who underwent PCNL or miniPerc with lithotripsy using the new EMS Lithoclast Trilogy or EMS Lithoclast Master. The procedure was carried out with all patients in prone position, by the same surgeon. The working channel size was 24 Fr–15.9 Fr. We evaluated the stones’ features, operative time, fragmentation time, complications, stone clearance rate and stone-free rate. Results: Our study included 59 patients, 38 females and 31 males, of an average age of 54.5 years old. The Trilogy group included 28 patients and the comparator included 31 patients. Urine culture was positive in seven cases which required seven days of antibiotics. The mean stone diameter was 35.6 mm with a mean Hounsfield unit (HU) of 710.1. The average number of stones was 2.08 (6 complete staghorn stones and 12 partial staghorn stones). A total of 13 patients presented a JJ stent (46.4%). We found a very significant difference in all the parameters favoring the Trilogy device. The most important result in our opinion is the probe active time, which was almost six times shorter in the Trilogy group. The stone clearance rate was about double in the Trilogy group, leading to shorter overall and intra-renal operating times. The overall complication rate was 17.9% in the Trilogy group and 23% in the Lithoclast Master group. The mean hemoglobin drop was 2.1 g/dL with a mean creatinine rise of 0.26 mg/dL. Conclusions: Swiss LithoClast® Trilogy, a device combining ultrasonic and ballistic energy, is a safe and efficient method of lithotripsy for PCNL, proving statistically significant benefits over its predecesor. It can achieve the goal of reducing complication rates and operative times for PCNL.

show abstract

“…However, the risk is always the most important consideration for surgeons. Therefore, many review articles and meta-analyses have been published comparing PCNL with other endoscopic methods of surgery such as ECIRS, which has a better stone clearance rate, fewer complications, and less blood transfusion compared with PCNL [ 10 ]. However, due to its cost, operation position and need for two groups of urologists, not many patients are ultimately suitable for ECIRS.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Nephrolithotomy Combined Antegrade Flexible Ureteroscope for Complete Staghorn Stones: A Case Report of a New Concept of Stone Surgery

et al. 2022

View full text Add to dashboard Cite

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn stones. However, residual stones in calyces remain a challenge due to the limited angle which makes the approach difficult. The new operative technique of endoscopic combined intrarenal surgery (ECIRS), which integrates the advantages of PCNL and retrograde intrarenal surgery (RIRS), was developed to overcome this difficulty. However, two experienced urologists are required to perform ECIRS, and the patient has to be placed in the Galdakao-modified supine Valdivia position or modified prone split-leg position which cannot be achieved in the elderly or patients with ankylosing arthritis, as it may cause harm due to abnormal traction of the joints. In addition, it is difficult for surgeons to create an ideal access tract to perform PCNL in this position. We report the case of a 72-year-old female patient with left staghorn stone. We performed RIRS first and then placed the patient in the decubitus position for PCNL with antegrade flexible ureteroscopy. This method allows patients to be placed in an easier position, with the use of flexible ureteroscopy through a nephroscope to find previously unreachable stones. Moreover, in addition to the more comfortable position both for surgeons and patients, this procedure can also deal with large complex renal stones as with ECIRS. We also created a brand-new definition for stone clearance rate, namely, stone reduction efficiency (SRE). There was a high stone reduction efficiency of 12.64 (mm2/min) in our patient, and no complications occurred. We suggest that this procedure is an ideal alternative treatment for a huge staghorn stone instead of PCNL or ECIRS.

show abstract

Endoscopic Combined Intrarenal Surgery Versus Percutaneous Nephrolithotomy for Complex Renal Stones: A Systematic Review and Meta-Analysis

Cited by 18 publications

References 31 publications

The use of endoscopic combined intrarenal surgery in the treatment of nephrolithiasis

The use of endoscopic combined intrarenal surgery in the treatment of nephrolithiasis

Single-Center Experience with Swiss LithoClast® Trilogy for Kidney Stones

Percutaneous Nephrolithotomy Combined Antegrade Flexible Ureteroscope for Complete Staghorn Stones: A Case Report of a New Concept of Stone Surgery

Contact Info

Product

Resources

About