Endoscopic combined intrarenal surgery in the prone split-leg position versus Galdakao-modified supine Valdivia position for the management of partial staghorn calculi

Abstract

Objective: To evaluate and compare the outcome of ECIRS in the treatment of partial staghorn renal calculi in both prone split-leg positions versus GMSV positions with regard to; technical aspects, success rate, operative time, complications, safety, and effectiveness of both approaches. Patients and methods: Between October 2018 and August 2021, 66 patients with partial staghorn calculi were enrolled in this prospective comparative study. Patients were randomly divided according to a 1:1 ratio into two groups. Group A included 33 patients who were treated by (ECIRS) in the prone split-leg position, and group B included 33 patients who were treated by (ECIRS) in the Galdakao-modified supine Valdivia (GMSV) position. Results: No significant statistical difference between both groups regarding the mean age (p = 0.448), mean body mass index (BMI) (p = 0.137), mean stone burden (p = 0.435), mean operative time (p = 0.541) and the number of calyces located in branched stones (p = 0.628). The mean hospital stay was 6.71 ± 1.12 days for group A and 6.66 ± 1.10 days for group B patients (p = 0.724). The final SFR was achieved in (29)87.87% and (30)90.9% of group A & B patients, respectively (p = 0.694). No significant difference was detected between both groups in perioperative complication rates. Conclusion: ECIRS is safe and effective in treating partial staghorn calculi either in the prone split-leg position or in the Galdakao-modified supine Valdivia position, with comparable outcomes and no statistically significant difference between both positions.

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

“…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 ].…”

“…Although miniPCNL is associated with a higher rate of tubeless procedures, nephrostomy placement remains the standard of care in larger stones [ 17 ]. In ECIRS, the urinary tract (especially in the supine position) can be accessed for residual fragments and is usually stented subsequently with both a Double-J ureteral stent and a nephrostomy tube [ 18 , 21 , 22 ]. In non-tubeless miniPCNL procedures, the RPP should allow the same bedside evaluation of ureteral patency.…”

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

“…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]. 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].…”

“…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]. 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].…”