Safety and Feasibility of Salvage Endoscopic Combined Intrarenal Surgery in Embolized Kidney

Abstract

Background: Although endoscopic combined intrarenal surgery (ECIRS) is well established as primary approach to complex lithiasis, no evidences are still available on its use in salvage context.Case Presentation: A male patient, of 55 years of age, underwent many unsuccessful surgical procedures to treat large and multiple right kidney stones, including percutaneous nephrolithotomy (PCNL). The latter was complicated by severe postoperative hemorrhage, managed with super-selective renal artery embolization (SRAE). Therefore he came to our institution to achieve a complete resolution of the urolithiasis. Preoperative evaluation included CT scan and renal scintigraphy to establish kidney and stone morphologic features and residual renal function. Salvage ECIRS was performed and postoperative assessment showed a complete resolution of lithiasis and absence of renal function impairment.Conclusion: To our knowledge, this is the first case of salvage ECIRS reported in literature after previous failed PCNL. Even after SRAE, this procedure appears as safe and as efficacious as standard salvage PCNL when performed by experienced hands.

Real-time simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: Washout mechanism and transport technique

“…In addition, the advantage of real-time flexible ureterorenoscopy is that the anatomical structure can be understood in a complex way through two video systems. Even when multi-tract PCNL is needed, the number of tracts can be reduced because of simultaneous RIRS, and it is also safe to remove the renal stone with anatomical difficulty [ 19 20 ]. As the number of nephrostomy tracts increases, renal parenchymal loss and bleeding may be developed [ 21 ].…”