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Updated: Jun 17, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
First Worldwide Multicentric Series of Mini-Ecirs in Children: Outcomes from Two Tertiary Endourology Centers
Yesica Quiroz1, Stefania Ferretti2, Davide Campobasso2
1Department of Paediatric Urology, Fundacio Puigvert, Barcelona, Spain.
Insights
Mini-Endoscopic Combined Intrarenal Surgery (Mini-ECIRS) offers a safe and effective approach for pediatric kidney stones, reducing the need for multiple procedures. This technique demonstrates a high stone-free rate in children with complex renal lithiasis.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Nephrolithiasis Treatment
Background:
- Endoscopic Combined Intrarenal Surgery (ECIRS) combines retrograde and antegrade approaches for complex renal stones, aiming to reduce complications associated with multiple percutaneous nephrolithotomy sessions.
- Pediatric urolithiasis often requires complex management, and minimally invasive techniques are preferred to minimize morbidity.
Purpose of the Study:
- To evaluate the clinical outcomes of Mini-ECIRS in a pediatric population.
- To assess the feasibility, safety, and efficacy of Mini-ECIRS for treating large or complex renal stones in children.
Main Methods:
- A retrospective study of 32 pediatric patients treated with Mini-ECIRS between 2006 and 2023 across two European referral centers.
- Data collected included demographics, stone characteristics, operative details (laser settings, access sheath size), operative time, stone-free rate (SFR), and complications.
- Statistical analysis involved Pearson's chi-squared test, Fisher's test, and logistic regression.
Main Results:
- The mean age of patients was 9.8 years, with 56.3% being girls. Mean stone size was 21.5mm, and 53.1% had multiple stones.
- The stone-free rate (SFR) was 75%. Factors significantly impacting success included stone size, volume, hardness, complexity, and lack of retrograde lithotripsy.
- The procedure had a low complication rate (18.8%), with one instance of collecting system perforation managed conservatively. Postoperative fever and one case of urinary sepsis were noted.
Conclusions:
- Mini-ECIRS is a feasible, safe, and efficient treatment option for complex pediatric renal lithiasis.
- This minimally invasive approach can effectively reduce the number of procedures required to achieve a stone-free status in children.
- Further multicenter studies are warranted to validate these findings on a larger scale.
Abstract:
Introduction: Endoscopic combined intrarenal surgery (ECIRS) is a combination of both retrograde and antegrade approaches for treatment of large or complex renal stones in one procedure, that are currently being treated with multiple tracts or sessions of percutaneous nephrolithotomy, increasing the complications. The aim of our study is to describe the clinical outcomes of Mini-ECIRS in a pediatric population. Material and Methods: A retrospective study was performed in pediatric patients with lithiasis disease treated with mini-ECIRS between 2006 and 2023 in 2 referral centers in Europe. Demographic data, clinical data, stone size and location, laser settings, intraoperative variables, stone-free rate (SFR) and complications were collected. Pearson's chi-squared test, Fisheŕs test and logistic regression, were performed. Results: A total of 32 mini-ECIRS were included. The mean age was 9,8 years, 56.3% girls. The mean size and volume of the stone were 21.5mm and 3298, 2mm3, 53.1% were multiple. Ureteral access sheath was used in 93.8% of the surgeries and only 37.5% had preoperative JJ stent. 53.1% of percutaneous access were with 14 Fr sheath. High power laser was the most frequent energy source for lithotripsy, including thulium fiber laser. The mean operative time was 166,6 minutes. There was one perforation of the collecting system that was managed with JJ stent and in the postoperative period 81.2% of the patients had no complications. Three presented fever, 1 developed urinary sepsis, and 1 required reintervention. The SFR was 75% and the size, volume, hardness, and complexity of the lithiasis, as well as the non-use of lithotripsy in the retrograde approach were statistically significant in decreasing the success of the surgery. Conclusions: ECIRS is a feasible, safe, and efficient procedure in children with complex renal lithiasis, decreasing the number of procedures needed for stone free. Multicenter studies are required to validate these results on a population scale.
