Endoscopic combined intrarenal surgery for large calculi: simultaneous use of flexible ureteroscopy and mini-percutaneous nephrolithotomy overcomes the disadvantageous of percutaneous nephrolithotomy monotherapy

J Endourol. 2014 Jan;28(1):28-33. doi: 10.1089/end.2013.0361. Epub 2013 Oct 24.


Background and purpose: Percutaneous nephrolithotomy (PCNL) is considered the standard procedure for the removal of large renal calculi. The development of the "minimally invasive PCNL" (mini-PCNL) has reduced the complications of the surgery; it also appears to be associated with less morbidity than the conventional PCNL (con-PCNL). This study aimed at evaluating the efficacy of endoscopic intrarenal surgery, using the prone-split leg position, using flexible ureteroscopy and mini-PCNL (mini- endoscopic combined intrarenal surgery [ECIRS]) by retrospectively comparing this technique with mini-PCNL and con-PCNL.

Patients and methods: In total, 161 consecutive patients who were observed for the follow-up of large renal calculi between February 2004 and January 2013 were selected for mini-ECIRS (60), mini-PCNL (19), or con-PCNL (82). Mini-ECIRS was performed with patients in the prone split-leg position via 18F minipercutaneous tract and 14F ureteral access sheath. The mini-PCNL was performed via 18F percutaneous tract and con-PCNL performed via the 30F tract. Mean size of the renal calculi removed via mini-ECIRS, mini-PCNL, and con-PCNL were 39.2, 38.4, and 34.6 mm, respectively.

Results: Average surgical time for mini-ECIRS was shorter than that for mini-PCNL and con-PCNL (120.5 vs. 181.9 vs 134.1 min, respectively; P<0.001). The stone-free rate for mini-ECIRS was significantly higher than that of the other procedures (initial rates 81.7% vs. 38.9% vs. 45.1%, respectively; P<0.001; rates after further treatment 86.7% vs. 61.1% vs. 61.0%, respectively; P=0.002). Only one patient in the mini-ECIRS group needed blood transfusions. The decrease in hemoglobin during mini-ECIRS and mini-PCNL was significantly lower than that during con-PCNL (P=0.011).

Conclusion: Mini-ECIRS is better than monotherapy with mini-PCNL or con-PCNL. The study results show that mini-ECIRS is a safe, efficient, and versatile procedure that can be effective for the management of renal calculi.

MeSH terms

  • Adult
  • Endoscopy / adverse effects*
  • Endoscopy / instrumentation
  • Endoscopy / methods
  • Female
  • Humans
  • Kidney Calculi / epidemiology
  • Kidney Calculi / surgery*
  • Male
  • Middle Aged
  • Nephrostomy, Percutaneous / adverse effects*
  • Nephrostomy, Percutaneous / instrumentation
  • Nephrostomy, Percutaneous / methods
  • Postoperative Complications
  • Retrospective Studies
  • Ureteroscopy / adverse effects*
  • Ureteroscopy / instrumentation
  • Ureteroscopy / methods