Abstract: PD21-12
Sources of Funding: None

Introduction

ECIRS (Endoscopic Combined IntraRenal Surgery) in the Galdakao-modified supine Valdivia position is an evolution of the traditional prone percutaneous nephrolithotomy (PNL) for the treatment of large/complex urolithiasis, combining an antegrade rigid and flexible approach with retrograde flexible ureteroscopy. The aim of the present work is to report our 12-years experience, highlighting ECIRS safety and efficacy.

Methods

We performed 310 consecutive ECIRS (11/2010-11/20169 standardized step-by-step pre-, intra- and post-operatively. The semirigid 6.5F Wolf ureteroscope and the flexible Storz FlexX2/C ureteroscopes were used for retrograde access. Percutaneous access was gained under ultrasound-assisted biplanar fluoroscopy guidance +/- Endovision contribution (24 Ch in 65% of the cases, 30 Ch in 31%, smaller accesses in 4%), using in 78% one-step balloon dilation.

Results

Mean age of the 310 patients (210 males, 100 females) was 55 years +/- 20 s.d. (range 19 months-82 years). The ASA score was 1-3, mean BMI 30 kg/m2 +/- 5 s.d., 10% urinary malformations, 7% skeletal deformities, 74% symptomatic for UTI/colics. Urolithiasis (206 left, 104 right renal stones, 15% bilateral, all compositions) had a mean stone size 51 mm +/- 22 s.d. (range 13-72 mm). Stones were single in 55%, multiple/staghorn in 45% of cases, with 24% coexistent ureteral stones. Mean operative time was 88 minutes +/- 35 s.d., including patient positioning. Preliminary semirigid ureteroscopy was performed in 81% of cases, additional flexible ureteroscopy in 53%. Endovision aid to fluoroscopy/ultrasound renal access (90% inferior calyx, 94% single access) was possible in 39% of cases. Retrograde ureteroscopy (ureteral stone treatment, in situ lithotripsy, stone fragments retrieval in calyces parallel to the access tract,…) had an active role in 54% of cases. The stone-free rate was 89.8%, 94.3% after an early second percutaneous look during the same hospital stay. The overall complication rate was 7.4% (1.6% of cases Clavien 3 and never more, no ureteral lesions). Mean fluoroscopy time of the “really-endoscopic� cases was 3.3 minutes +/- 1.2 s.d., versus 5.5 +/- 3 s.d. of the other ECIRS.

Conclusions

ECIRS represents a comprehensive approach to PNL, personalizing stone management and tailoring all intraoperative choices on the patient. Retrograde flexible ureteroscopy, after preliminary evaluation of the dynamic anatomy of collecting system and stones, actively contributes to safety and efficacy of ECIRS, optimizing stone-free rates and reducing complications and radiation exposure.

Funding

None