ECIRS (Endoscopic Combined Intrarenal Surgery) Versus Fluoroscopic-guided Renal Access during supine Percutaneous Nephrolithotomy (PCNL): A Comparative Study

Stylianos Kontos, Athanasios Papatsoris, Sarath K Nalagatla

Abstract


Objective: To evaluate the intra- and post-operative outcomes
of percutaneous renal access using either ECIRS (Endoscopic
Combined Intrarenal Surgery) or fluoroscopic-guided renal
access for supine percutaneous nephrolithotomy (PCNL).
Methods: In our institute, over a 24-month period (April 2012
to March 2014), two surgeons performed a total of 68 PCNLs
(not consecutive staghorn stone cases); 33 ECIRS and 35 fluoroscopically-
guided access (FGA). All patient and calculi demographics
were recorded, as well as intra-operative parameters
and complication/secondary procedure rates.
Results: We demonstrate that ECIRS offers rapid operating time
(total procedure time 113 vs. 142 min, p<0.05), low complication
rates (sepsis (0% vs. 5.8%), transfusion (0% vs. 8.6%) or
bowel injury (0%)), with reduced in-patient stay (2 vs. 4 days,
p<0.05) and high rates of stone clearance/residual fragments
<4mm (3% vs. 25.7%, p<0.05) and low rate of secondary
procedure (6.1% vs. 31.4%, p<0.05).
Conclusion: ECIRS offers shorter operating times, with low
complication rates, higher rates of stone clearance and a reduced
requirement for secondary procedures in comparison to purely
FGA. We envisage that this is due to a combination of quicker
and more accurate needle placement, as well as the ability to
perform concomitant FURS and laser stone fragmentation.


Keywords


combined nephrolithotomy;renal puncture;learning curve

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References


Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new

extraction technique. Scandinavian journal of urology and nephrology.

;10(3):257-259.

Papatsoris AG1, Zaman F, Panah A, Masood J, El-Husseiny T, Buchholz

N. Simultaneous anterograde and retrograde endourologic

access: “the Barts technique”.J Endourol. 2008 Dec;22(12):2665-6

Grasso M, Lang G, Taylor FC. Flexible ureteroscopically assisted

percutaneous renal access. Techniques in urology. Spring

;1(1):39-43.

Kidd CF, Conlin MJ. Ureteroscopically assisted percutaneous renal

access. Urology. Jun 2003;61(6):1244-1245.

Khan F, Borin JF, Pearle MS, McDougall EM, Clayman RV. Endoscopically

guided percutaneous renal access: “seeing is believing”. Journal

of endourology / Endourological Society. Jul 2006;20(7):451-

; discussion 455.

Sountoulides PG, Kaufmann OG, Louie MK, et al. Endoscopy-guided

percutaneous nephrostolithotomy: benefits of ureteroscopic access

and therapy. Journal of endourology / Endourological Society. Oct

;23(10):1649-1654.

Isac W, Rizkala E, Liu X, Noble M, Monga M. Endoscopic-guided

versus fluoroscopic-guided renal access for percutaneous nephrolithotomy:

a comparative analysis. Urology. Feb 2013;81(2):251-

Stoller ML, Wolf JS, Jr., St Lezin MA. Estimated blood loss and

transfusion rates associated with percutaneous nephrolithotomy.

The Journal of urology. Dec 1994;152(6 Pt 1):1977-1981.

Borin JF. Prone retrograde laser lithotripsy facilitates endoscope-

guided percutaneous renal access for staghorn calculi: two

scopes are better than one. Journal of endourology / Endourological

Society. Sep 2008;22(9):1881-1883.

de la Rosette JJ, Laguna MP, Rassweiler JJ, Conort P. Training in

percutaneous nephrolithotomy--a critical review. European urology.

Nov 2008;54(5):994-1001.

Watterson JD, Soon S, Jana K. Access related complications

during percutaneous nephrolithotomy: urology versus radiology

at a single academic institution. The Journal of urology. Jul

;176(1):142-145.

Papatsoris AG , Shaikh T, Patel D, Bourdoumis A, Bach C, Buchholz

N, Masood J, Junaid I. Use of a virtual reality simulator to improve

percutaneous renal access skills: a prospe




DOI: http://dx.doi.org/10.19264/hj.v30i3.241