Nationwide Transition From Percutaneous Nephrolithotomy to Endoscopic Combined Intrarenal Surgery in Japan: A...

To clarify the national transition from conventional percutaneous nephrolithotomy (PCNL) to endoscopic combined intrarenal surgery (ECIRS) and evaluate their safety profiles based on real-world data.

A retrospective nationwide survey was conducted at 233 institutions in Japan that provided data on percutaneous kidney stone surgeries performed between April 2019 and March 2022. Annual procedure volumes, surgical positions, tract size, irrigation methods, and perioperative complications were analyzed.

Among 5555 cases, 1618 were PCNL and 3937 were ECIRS. PCNL decreased significantly over the study period, whereas ECIRS increased and accounted for approximately 75% of the cases by 2021. The GMSV position was used in 81% of ECIRS cases, whereas 76% of PCNL cases were performed in the prone position (p < 0.001). Mini-tracts (< 23 Fr) were used in 75.3% of ECIRS and 49.5% of PCNL (p < 0.001). Severe bleeding (4.7% vs. 1.5%, p < 0.001) and blood transfusion (2.0% vs. 0.7%, p = 0.001) occurred more frequently in PCNL than in ECIRS. Postoperative fever (17.1 vs. 19.2%) or sepsis (2.1 vs. 1.5%) were not significantly different.

Although this study was not designed to establish superiority between the procedures, it is the first one to compare the use of PCNL and ECIRS in Japan, and it suggests a marked paradigm shift toward ECIRS. The increasing use of mini-tracts and the hybrid retrograde-antegrade approach may be associated with a lower observed rate of bleeding complications. However, postoperative infections remain common with both techniques, highlighting the importance of intrarenal pressure control, optimal patient selection, and meticulous perioperative management.