Mini-PCNL and mini-ECIRS in a solitary kidney population: a single-center experience

To quantify the postoperative outcomes, namely complication rates and renal function, of mini-combined endoscopic combined intrarenal surgery (ECIRS) or mini-percutaneous nephrolithotomy (PCNL) within solitary kidney (SK) patients.

We relied on a single-centre retrospective database including 658 patients who underwent endourological surgeries for stone treatment, between 2018 and 2025. Endpoints, namely intraoperative and postoperative complications, length of stay (LOS), and renal function were quantified.

Based on a median follow-up of 15 months (IQR 6-35), 28 SK patients, for a total of 33 surgeries, were included. Out of 33 surgeries, 18 (55%) consisted of ECIRS and 15 (45%) were PCNL. The rates of SK patients who underwent surgeries ranged from 3% in 2018 to 14% in 2025. Out of all 33 surgeries, 14 (42%) were performed in Guy's stone score (GSS) ≥ III stones. Median volume of treated stones was 120 mm3 (IQR 12-305). Among 33 surgeries, five (15%) were associated with intraoperative complications and 12 (36%) were associated with postoperative complications (Clavien-Dindo IIIa, n = 1, 3%). Residual stones were present in 12 (36%) surgeries. According to renal function, no differences were recorded between pre-operative and either 3-mo eGFR (p = 0.2) or 6-mo eGFR (p = 0.2).

In this single-center European cohort, mini-ECIRS and mini-PCNL were feasible and safe treatment options for stones in SK patients, with acceptable postoperative outcomes. Nevertheless, larger prospective studies are needed to strengthen the current evidence.