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Purpose <p>Endoscopic Combined Intrarenal Surgery (ECIRS) has transformed the management of complex renal stones, offering potential advantages over conventional Percutaneous Nephrolithotomy (PCNL), including reduced need for secondary punctures and improved stone-free rates (SFR). This study aimed to compare surgical outcomes and complications between ECIRS and Supine PCNL (S-PCNL).</p> Methods <p>Data was prospectively collected from all consecutive patients treated with ECIRS or S-PCNL at a UK tertiary centre from 2008 to 2024. Surgical outcomes, complications, transfusion rates, and hospital stay were recorded. A 1:1 propensity score matching (PSM) method was used to minimize differences in baseline characteristics. The primary outcome was secondary puncture rate; secondary outcomes included SFR, complication rates, operative time, transfusion rate, and hospital stay.</p> Results <p>A total of 704 patients were included, with 186 (26%) undergoing ECIRS. After PSM, 176 matched pairs were analysed. ECIRS showed a significantly lower secondary puncture rate (2% vs. 7%, <i>p</i> = 0.01) and higher SFR (90% vs. 81%, <i>p</i> = 0.01). There were no significant differences in overall (16% vs. 14%, <i>p</i> = 0.7) or major complications (6% vs. 4.5%, <i>p</i> = 0.8), or in transfusion rates (0.6% vs. 1.1%, <i>p</i> = 0.7). ECIRS had a longer median operative time [72 vs. 65&#xa0;min, <i>p</i> = 0.03], while S-PCNL was associated with a longer hospital stay [3 vs. 2 days, <i>p</i> = 0.02].</p> Conclusions <p>ECIRS is a safe and effective technique for managing complex renal stones. The technique is associated with higher stone free rate and reduced need for secondary puncture compared to S-PCNL.</p>

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Endoscopic combined intrarenal surgery (ECIRS) versus supine percutaneous nephrolithotomy (S-PCNL): a propensity score matched study of surgical outcomes and complications

  • 期刊论文

  • 发表日期：

    2025年9月11日

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  • T. Fonseka,
  • G. Basile,
  • L. Ongaro,
  • S. Bhat,
  • L. Logrado,
  • F. Dionisio,
  • D. Allen,
  • P. Singh,
  • A. Goyal,
  • G. Ellis,
  • R. Kucheria,
  • A. Goode,
  • D. Yu,
  • L. Ajayi

摘要

Purpose

Endoscopic Combined Intrarenal Surgery (ECIRS) has transformed the management of complex renal stones, offering potential advantages over conventional Percutaneous Nephrolithotomy (PCNL), including reduced need for secondary punctures and improved stone-free rates (SFR). This study aimed to compare surgical outcomes and complications between ECIRS and Supine PCNL (S-PCNL).

Methods

Data was prospectively collected from all consecutive patients treated with ECIRS or S-PCNL at a UK tertiary centre from 2008 to 2024. Surgical outcomes, complications, transfusion rates, and hospital stay were recorded. A 1:1 propensity score matching (PSM) method was used to minimize differences in baseline characteristics. The primary outcome was secondary puncture rate; secondary outcomes included SFR, complication rates, operative time, transfusion rate, and hospital stay.

Results

A total of 704 patients were included, with 186 (26%) undergoing ECIRS. After PSM, 176 matched pairs were analysed. ECIRS showed a significantly lower secondary puncture rate (2% vs. 7%, p = 0.01) and higher SFR (90% vs. 81%, p = 0.01). There were no significant differences in overall (16% vs. 14%, p = 0.7) or major complications (6% vs. 4.5%, p = 0.8), or in transfusion rates (0.6% vs. 1.1%, p = 0.7). ECIRS had a longer median operative time [72 vs. 65 min, p = 0.03], while S-PCNL was associated with a longer hospital stay [3 vs. 2 days, p = 0.02].

Conclusions

ECIRS is a safe and effective technique for managing complex renal stones. The technique is associated with higher stone free rate and reduced need for secondary puncture compared to S-PCNL.