Endoscopic Combined Intrarenal Surgery vs Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Endoscopic combined intrarenal surgery (ECIRS) is an advanced technique for high stone burden or complex kidney stones.
• ECIRS may improve stone-free rates (SFR) and reduce complications compared to percutaneous nephrolithotomy (PCNL).
• Existing evidence largely stems from single-center, small-cohort studies.

Purpose of the Study:

• To systematically review and meta-analyze perioperative outcomes of ECIRS versus PCNL.
• To compare stone-free rates, complication rates, and other surgical outcomes between the two procedures.

Main Methods:

• Systematic search of PubMed, Embase, and Scopus databases for comparative studies (randomized and non-randomized).
• Primary outcomes: single-session SFR, need for ancillary treatments, major complications (Clavien-Dindo ≥3).
• Secondary outcomes: transfusion rates, operative time, hospital stay; random-effects models used for high heterogeneity.

Main Results:

• Fifteen studies (1988 patients) favored ECIRS with significantly higher SFR (OR 3.02) and lower need for ancillary procedures (OR 0.20).
• ECIRS also showed lower major complication rates (OR 0.58) and transfusions (OR 0.49).
• PCNL was associated with longer operative time (MD -9.25 min) and hospital stay (MD -1.61 days).

Conclusions:

• ECIRS achieves higher single-session SFR without increasing major complications or transfusion rates.
• ECIRS may reduce operative time and hospital stay, especially with experienced surgeons.
• Further randomized trials are needed to solidify ECIRS's clinical role due to the predominance of retrospective studies.