Ureteroscopy‐assisted puncture for ultrasonography‐guided renal access significantly improves overall treatment outcomes in endoscopic combined intrarenal surgery

Abstract

Objectives: To assess the impact and availability of ureteroscopy-assisted puncture for percutaneous renal access during ultrasonography-guided miniaturized (mini)-endoscopic combined intrarenal surgery for large volume renal and/or proximal ureteral stones. Methods: We conducted a multi-institutional retrospective cohort study for urolithiasis treatment. Data from a total of 313 patients who underwent mini-endoscopic combined intrarenal surgery to treat renal and/or ureteral stones between January 2016 and April 2020 were collected. We compared the outcomes between ultrasonography-guided miniendoscopic combined intrarenal surgery with and without ureteroscopy-assisted puncture (ureteroscopy-assisted puncture(+) group [n = 126] and ureteroscopy-assisted puncture(À) group [n = 187] group, respectively). The primary outcome was requirement for additional surgical intervention. Secondary outcomes were stone-free rate, complications and total procedure, fluoroscopy, hospital stay, and postoperative ureteral stent placement durations. Results: The ureteroscopy-assisted puncture(+) group had a lower additional surgical intervention rate and a higher stone-free rate immediately after and 3 months after surgery than the ureteroscopy-assisted puncture(À) group (5.6% vs 19.7%, P < 0.001; 82.5% vs 65.8%, P = 0.001; 59.5% vs 44.6%, P = 0.011). The median total procedure, fluoroscopy, and postoperative ureteral stent placement durations were 18 min, 3 min, and 5 days shorter, respectively, in the ureteroscopy-assisted puncture(+) group. Multivariate analyses showed that ureteroscopy-assisted puncture was associated with a decreased risk of additional surgical intervention (odds ratio 0.31, P = 0.011) and postoperative infection (odds ratio 0.34, P = 0.003) and decreased total procedure (estimate = À11 min; P = 0.011), fluoroscopy (estimate = À3 min; P = 0.034), and postoperative ureteral stent placement (estimate = À8 days; P = 0.011) durations. Female patients and those with smaller stone volumes or without hydronephrosis were identified as ideal ureteroscopy-assisted puncture candidates. Conclusions: Ureteroscopy-assisted puncture during mini-endoscopic combined intrarenal surgery could provide favorable surgical outcomes, especially in female patients without collecting system obstruction.

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

“…Recently, a number of works have appeared that offer to perform percutaneous access to the kidney under the visual guidance of a flexible ureterorenoscope, inserted into the target calyx. Thus, K. Taguchi et al [51] compared the results of percutaneous access to the kidney during ECIRS between two groups of patients: Group 1 (n = 126) -percutaneous access under ultrasound guidance with ureterorenoscopic imaging from the middle of the renal cavity system and Group 2 (n = 187) -traditional percutaneous access only under ultrasound guidance. In their work, the authors showed that puncture of the calyx-pelvic system (CPS) under combined ultrasound and ureterorenoscopic guidance was associated with a lower risk of additional surgery (OR = 0.31; P = 0.011), reducing the number of postoperative infectious complications (OR = 0.34; P = 0.003), the total duration of the procedure (less by 11 minutes; P = 0.011), radioscopy (less by 3 minutes; P = 0.034) and the duration of postoperative ureteral stenting (less by 8 days; P = 0.011).…”

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

“…From the very first article in 2008 reporting that ECIRS in GMSV position in their 127 patients yielded excellent single-step SFR with minimal complications and unquestionable anaesthesiologic advantages [1], their results have been time tested and repeatedly verified as seen in multiple stated studies above [8,10,14 ▪ ,18 ▪▪ ,23 ▪▪ ,24,25 ▪▪ ,26,34,36]. Indeed, this is evident from the fact that ECIRS is now being performed in multiple positions with miniaturized and single access and even under ultrasound guidance.…”

“…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.…”

“…Yet, four studies compared ECIRS in different patient positions [19 ▪ ,27,32,38]. Regarding percutaneous size tract, there were 19 studies using a standard PCNL [1,2 ▪ ,6,7,9,11–13,17,19 ▪ ,20,21,27–29,31–33,38] tract and 9 a mini-PCNL tract [8,10,14 ▪ ,18 ▪▪ ,23 ▪▪ ,24,25 ▪▪ ,34,36]. Only one study compared standard vs. mini-ECIRS [26].…”

“…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]. There were 16 single-arm studies [1,2 ▪ ,6,7,9–11,13,17,20,21,25 ▪▪ ,28,31,33,36], whilst 7 studies compared ECIRS with other procedures [8,12,14 ▪ ,18 ▪▪ ,24,26,34]. Yet, four studies compared ECIRS in different patient positions [19 ▪ ,27,32,38].…”