Endoscopic Combined Intra Renal Surgery versus Percutanous Nephrolithotomy: utcomes of a matched case-control analyis

To compare the efficacy and safety outcomes of Endoscopic Combined Intrarenal Surgery (ECIRS) and Percutaneous Nephrolithotomy (PCNL) in the treatment of kidney stones.

A retrospective matched case-control study was conducted from July 2022 to January 2024, utilizing prospectively collected kidney stone databases from two centers. Patients who underwent PCNL or ECIRS for kidney stone treatment were included. Cases and controls were matched based on stone complexity, using the Guy's Stone Score (GSS) in a 1:2 ratio. Computed tomography (CT) was performed 90 days postoperatively to assess the stone free rate, defined as the absence of residual fragments. The analyzed variables included age, sex, body mass index (BMI), ASA score, comorbidities, stone diameter, GSS, operative time, number of accesses, blood transfusions, hemoglobin drop, hospital stay, stone free rate, and complication rates. Statistical analysis was performed using the Student's t-test for continuous variables and the Chi-square or Fisher's exact test for categorical variables, with significance set at p < 0.05.

A total of 165 patients were included (55 in the ECIRS group and 110 in the PCNL group). Demographic characteristics were comparable between groups. ECIRS demonstrated a higher stone-free rate (81.8% vs. 56.4%; p = 0.001), particularly in complex cases (GSS 3 and 4) (79.2% vs. 41.7%; p = 0.003). There was no significant difference in complication rates between the two groups (21.8% vs. 26.4%; p = 0.607).

ECIRS is an effective treatment, particularly for large and complex kidney stones, offering higher success rates compared to PCNL, with similar complication rates.