Minimally invasive versus standard endoscopic combined intrarenal surgery for renal stones: a retrospective pilot study analysis

Usui, Kimitsugu; Komeya, Mitsuru; Taguri, Masataka; Kataoka, Koshi; Asai, Tomohiro; Ogawa, Takehiko; Yao, Masahiro; Matsuzaki, Junichi

doi:10.1007/s11255-020-02433-x

Cited by 21 publications

(20 citation statements)

References 18 publications

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“…It should be noted that the most dangerous complication of percutaneous access to the kidney is bleeding, the risk of which increases with increasing numbers of accesses in cases of staghorn renal stones, and it is observed with standard PNL in 6.1-7.0 % of patients in the prone position and in 4.3 % in the supine position. With the above-mentioned pathology ECIRS seems safer, because according to some authors, bleeding in these surgeries is observed twice less often (0.5-3.0 %) and this is obvious and quite understandable, because in most cases it is performed through one percutaneous access [31][32][33].…”

Section: Resultsmentioning

confidence: 99%

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

Postol

Sahalevych²,

Serhiichuk³

et al. 2022

ZMJ

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Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment. Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods. Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety. Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy. Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive.

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Section: Resultsmentioning

confidence: 99%

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

Postol

Sahalevych²,

Serhiichuk³

et al. 2022

ZMJ

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“…Supine position was also associated with lower high-grade complication rates [ 27 ]. The downwardly orientated access sheath could have provided better drainage and prevented high intrarenal pressures, thus lowering infections in supine position [ 28 ]. Nonetheless, our results do not show high urinary infections rates nor urinary tract injuries.…”

Section: Discussionmentioning

confidence: 99%

Nonpapillary prone endoscopic combined intrarenal surgery: effectiveness, safety and tips, and tricks

et al. 2022

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Purpose To evaluate the effectiveness and safety of nonpapillary prone endoscopic combined intrarenal surgery (ECIRS) and provide practical tips and tricks for the successful accomplishment of the procedure respecting the anatomical particularities. Material and methods This study is an analysis of a prospectively collected database including all cases of ECIRS performed between January 2019 and December 2021 in a high-volume tertiary center. All patients underwent the procedure in prone-split leg position. A nonpapillary renal puncture was performed. The used access sheaths were 22Fr or 30Fr. Lithotripsy was performed anterogradely with a dual-energy lithotripter with incorporated suction and retrogradely with holmium Yttrium–Aluminum–Garnet laser. Results A total of 33 patients were included. The initial stone-free rate (SFR) was 84.8% and the final SFR was 90.9%. The median stone size was 35 mm and 60% of patients had staghorn calculi. The prevalence of renal abnormalities was 21.3%, including 3 cases of horseshoe kidney, 2 cases of malrotation and 2 cases with complete duplicated systems. The median operative time was 47 min. The median hospital stay was 3 days and median hemoglobin loss was 1.2 gr/dL. Overall, the complication rate was 9.1%, all being Grade II complications (n = 2 fever and n = 1 transient bleeding). Conclusions Nonpapillary prone ECIRS is an effective and safe procedure. Standardization of the procedure is critical to achieve good outcomes. Patients who benefit the most are probably the ones where additional punctures can be avoided using this technique, namely patients with renal abnormalities, incrusted ureteral stents and staghorn stones.

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“…Previous studies have reported that the rate of f-UTIs in endourological surgery was < 5% 25 , but we included ECIRS cases in this study. In ECIRS cases, f-UTIs onset is reported up to 10–20% 26 , 27 ; based on that and considering that the ratio of ECIRS in endourological surgery at our facility was approximately 10%, we set the incidence of f-UTIs to 5% in the surgical hand hygiene group, and to 7.5% in the regular hand hygiene group because of increased risk of infection owing to omission of conventional disinfection practices. The difference in the incidence of f-UTI due to the presence or absence of surgical hand washing was within a permissible range of up to 4%, the detection power was 80%, the significance level was 5% on two side, and we calculated the sample size for comparison of the ratio of two groups (non-inferiority) according to a statistician's consultation.…”

Section: Methodsmentioning

confidence: 99%

Surgical hand hygiene and febrile urinary tract infections in endourological surgery: a single-centre prospective cohort study

Unno

Taguchi

Fujii

et al. 2020

Sci Rep

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Surgical hand hygiene reduces the risk of surgical site infections (SSIs). SSIs are not considered an issue in endourological surgery, whereas febrile urinary tract infections (f-UTIs) and urological sepsis are becoming problematic. We wondered whether surgical hand hygiene is necessary for endourological surgery. Therefore, we aimed to evaluate the influence of surgical hand hygiene on f-UTI onset in endourological surgery by comparing procedures in which surgical hand hygiene with double gloving was used with those in which regular hand hygiene with double gloving was used between April 2016 and July 2020. In this prospective cohort study of 477 patients who underwent endourological surgeries, surgeons in the surgical hand hygiene and regular hygiene groups performed surgery on 259 and 218 patients, respectively. There was no significant difference in patient background, and multivariate analyses revealed no significant differences in f-UTI onset (odds ratio, 0.87; p = 0.74) between the two groups. In conclusion, regular hand hygiene with double gloving may be considered an alternative to surgical hand hygiene to prevent endourological f-UTIs, which could alter operational protocols for endourological surgery. Further studies are needed to validate our findings.

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Minimally invasive versus standard endoscopic combined intrarenal surgery for renal stones: a retrospective pilot study analysis

Cited by 21 publications

References 18 publications

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

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

Nonpapillary prone endoscopic combined intrarenal surgery: effectiveness, safety and tips, and tricks

Surgical hand hygiene and febrile urinary tract infections in endourological surgery: a single-centre prospective cohort study

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