A retrospective analysis of modern endoscopic surgery for nephrolithiasis: ECIRS with advantages

This study aims to evaluate the operative safety and clinical outcomes of endoscopic combined intrarenal surgery (ECIRS) compared to the established techniques (PCNL, mini-PCNL) treating kidney stones.

Patients who underwent endoscopic surgery for kidney stones between 2013 and 2024 at the university hospital of Wuerzburg were divided into three (ECIRS, PCNL, mini-PCNL) groups and retrospectively analysed. Comparison was performed using t-, chi-square-tests and ANOVA.

A total of 185 patients were allocated to three groups and compared. Among them, 98 patients underwent standard PCNL, 48 patients were assigned to the mini-PCNL group, and 39 patients to the ECIRS group. Considering comparable characteristics regarding nephrolithiasis and postoperative complications, the ECIRS group demonstrated significantly shorter operative times (85 vs. 125 vs. 115min, p<0.001), fluoroscopy durations (3.7 vs. 7.7 vs. 5.8 min, p<0.001), and lengths of hospital stay (8.2 vs. 12.7 vs. 9.2 days, p<0.001) compared to PCNL and mini-PCNL. The stone-free rates showed a trend to be superior in the ECIRS group, while complication rates and the need for re-interventions within 30 days were comparable among the groups analysed. Additional benefits of ECIRS were identified in the subgroup analysis. In patients with multiple stones (two or more), subgroup analysis confirmed significant shorter operative and fluoroscopy times and shorter hospital stays with ECIRS, while also revealing better postoperative renal function and a trend toward higher stone-free rates compared to mini-PCNL.

ECIRS technique is a safe and effective endoscopic option for managing complex kidney stones, offering reduced operative and fluoroscopy times as well as shorter hospital stays. Future studies with larger patient cohorts may further elucidate the advantages of the ECIRS approach and refine its indications to identify patients who would benefit most from this technique.