Endoscopic combined intrarenal surgery versus prone percutaneous nephrolithotomy for complex renal stones: critical...

To evaluate the efficacy and safety of endoscopic combined intrarenal surgery (ECIRS) in the Galdakao-Modified Supine Valdivia (GMSV) position versus percutaneous nephrolithotomy (PCNL) in the prone position for managing complex kidney stones.

This prospective, randomized study was conducted in the urology departments of Benha University Hospital and Theodor Bilharz Research Institute between June 2021 and May 2024. A total of 60 patients with complex renal stones were randomly assigned to two groups (30 patients each). Group A underwent conventional percutaneous nephrolithotomy (PCNL) in the prone position, while Group B underwent endoscopic combined intrarenal surgery (ECIRS) in the Galdakao-Modified Supine Valdivia (GMSV) position. Data on demographic characteristics, clinical outcomes, perioperative parameters, and stone-free rates (SFR) were collected.

No significant differences were found between the two groups regarding preoperative demographic data and stone characteristics. However, operative time was significantly longer in the PCNL group (119 ± 18 min) compared to the ECIRS group (105 ± 14 min) (P = 0.002). The number of punctures was also significantly higher in the PCNL group than in the ECIRS group (P = 0.001). Immediate success was notably higher in the ECIRS group (83.3%) compared to the PCNL group (53.3%) (P = 0.012). However, no significant difference was observed between the groups concerning eventual success (P = 1.0).

ECIRS is a highly effective treatment for complex renal stones, delivering favorable outcomes such as higher single-step stone-free rates, a lower incidence of adverse events, and a reduced need for auxiliary procedures.