Endoscopic Combined Intrarenal Surgery Versus Percutaneous Nephrolithotomy for Complex Renal Stones: A Systematic...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Treatment

Background:

• Endoscopic combined intrarenal surgery (ECIRS) integrates ureteroscopic vision with percutaneous nephrolithotomy (PCNL).
• ECIRS is considered for complex renal stones, but its superiority over PCNL lacks consensus.
• Evidence comparing ECIRS and PCNL efficacy, safety, bleeding risk, and efficiency is analyzed.

Purpose of the Study:

• To critically analyze and compare the efficacy, safety, bleeding risk, and efficiency of ECIRS versus PCNL.
• To determine if ECIRS offers advantages in treating complex renal stones.

Main Methods:

• A meta-analysis was performed on seven studies involving 919 patients.
• Studies compared initial and final stone-free rates, postoperative fever, complication rates, hemoglobin drop, operative time, and hospital stay.
• Subgroup analysis included minimally invasive and conventional ECIRS.

Main Results:

• ECIRS demonstrated significantly higher initial and final stone-free rates.
• ECIRS resulted in lower overall and severe complications and reduced need for blood transfusions.
• No significant differences were found in postoperative fever, hemoglobin drop, operative time, or hospital stay.

Conclusions:

• ECIRS is superior to PCNL for complex renal stones, offering better stone clearance and safety profiles.
• ECIRS leads to fewer complications and reduced blood transfusion requirements.
• Both minimally invasive and conventional ECIRS approaches show consistent benefits.