The Safety and Efficacy of Endoscopic Combined Intrarenal Surgery (ECIRS) versus Percutaneous Nephrolithotomy (PCNL): A Systematic Review and Meta-Analysis

Abstract

Purpose. Our aim is to evaluate the safety and efficacy of endoscopic combined intrarenal surgery compared to percutaneous nephrolithotomy to guide practitioners and inform guidelines. Materials and Methods. A detailed database search was performed in PubMed, OVID, Scopus, and Web of Science in October 2021 to identify articles pertaining to ECIRS published between 2001 and 2021. Results. Four nonrandomized comparative studies and one RCT were identified, yielding five studies with a total of 546 patients (ECIRS/mini-ECIRS, n = 277; PCNL/mini-PCNL, n = 269). Subjects in these five studies met the predefined inclusion criteria established by two reviewers (J.E.A. and R.L.S.) and were therefore eligible for analysis. The results demonstrated that ECIRS was associated with a higher SFR (OR: 4.20; 95% CI: 2.79, 6.33; p < 0.00001 ), fewer complications (OR: 0.63; 95% CI: 0.41, 0.97; p = 0.04 ), and a shorter hospital stay (WMD: −1.27; 95% CI: −1.55, −0.98; p < 0.00001 ) when compared to PCNL. There were no statistically significant differences in blood transfusions (OR: 0.45; 95% CI: 0.12, 1.68; p = 0.24 ), operative time (SMD: −1.05; 95% CI: −2.42, 0.31; p = 0.13 ), or blood loss (SMD: −1.10; 95% CI: −2.46, 0.26; p = 0.11 ) between ECIRS and PCNL. Conclusions. ECIRS may be a more suitable approach for the surgical management of large and complex kidney stones currently indicating PCNL due to its superior efficacy with comparable surgical time and complication rate, though it is thought that a lack of resources and properly trained personnel may preclude ECIRS from becoming the standard. It is our impression that ECIRS may become the preferred technique in the endourologic community corresponding to the evolutionary sequence of percutaneous stone surgery.

Evolution and current applications of endoscopic combined intrarenal surgery: a scoping review from back to the future

“…The key focus was team work and versatility. It was only in 2022 that four authors actually published their meta-analysis focusing on different aspects of ECIRS [15,16,30,37 ▪ ]. Widyokirono et al [30] concluded that ECIRS is effective and well tolerated for large and complex nephrolithiasis, with significantly higher one-step SFR, a lower necessity for auxiliary procedures, and a lower complication rate compared with PCNL.…”

“…The remaining 162 full-text articles were further evaluated for appropriateness and 127 articles were excluded. Finally, 35 articles were considered eligible and included [1,2 ▪ ,6–13,14 ▪ ,15–17,18 ▪▪ ,19 ▪ ,20–22,23 ▪▪ ,24,25 ▪▪ ,26–36,37 ▪ ,38]. Figure 1 shows the flow diagram of the literature search.…”

“…There were six reviews [15,16,22,30,35,37 ▪ ]. There were 22 retrospective [6–13,14 ▪ ,17,19 ▪ ,20,24,25 ▪▪ ,26,28,31–34,36,38] and 7 prospective studies [1,2 ▪ ,18 ▪▪ ,21,23 ▪▪ ,27,29], and only one among the latter was randomized [29].…”

Hydrostatic pressure of the renal pelvis as a radiation-free alternative to fluoroscopic nephrostogram following percutaneous nephrolithotomy

“…), there is a clear trend toward miniPCNL [ 17 ]. Endoscopic combined intra renal surgery (ECIRS) is a more recent approach with the goal of minimizing the number of access tracts and improving the one-step SFR [ 18 – 20 ]. ECIRS can be performed in the prone position with the leg divided or in the supine position [ 21 ].…”

Classification and clinical significance of the posterior group of renal calyces

“…This in turn helps in the selection of the appropriate target calyces for prone PCNL, the establishment of surgical access with a precise puncture, improvement in efficient removal of the stones, and reduces complications. [20,21]…”