Mp29-02 Endoscopic Combined Intrarenal Surgery (Ecirs) Is Associated With a Lower Secondary Puncture Rate When Compared to Standard Supine Percutaneous Nephrolithotomy (S-Pcnl): Results From a Propensity Score Matched Analysis

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) III (MP29)1 May 2024MP29-02 ENDOSCOPIC COMBINED INTRARENAL SURGERY (ECIRS) IS ASSOCIATED WITH A LOWER SECONDARY PUNCTURE RATE WHEN COMPARED TO STANDARD SUPINE PERCUTANEOUS NEPHROLITHOTOMY (S-PCNL): RESULTS FROM A PROPENSITY SCORE MATCHED ANALYSIS Thomas Fonseka, Lara Logrado, Filipa Dionisio, Darrell Allen, Anuj Goyal, Gidon Ellis, Rajesh Kucheria, Antony Goode, Dominic Yu, and Leye Ajayi Thomas FonsekaThomas Fonseka , Lara LogradoLara Logrado , Filipa DionisioFilipa Dionisio , Darrell AllenDarrell Allen , Anuj GoyalAnuj Goyal , Gidon EllisGidon Ellis , Rajesh KucheriaRajesh Kucheria , Antony GoodeAntony Goode , Dominic YuDominic Yu , and Leye AjayiLeye Ajayi View All Author Informationhttps://doi.org/10.1097/01.JU.0001008680.67760.37.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endoscopic combined intrarenal surgery (ECIRS) is now a well-established surgical technique in the management of large and complex renal stones. The procedure carries the theoretical advantage of reducing the need for a secondary puncture. The primary objective of this study was to identify whether ECIRS was associated with a lower secondary puncture rate, when compared to standard supine PCNL (S-PCNL). Secondary outcomes measured were stone-free rate, complication rate and number of post-operative blood transfusions. METHODS: Data were prospectively collected on all consecutive patients undergoing either S-PCNL or ECIRS at a tertiary referral stone centre in London, UK from 2007 to 2023. S-PCNL was carried out using 30Fr access and ECIRS was performed in the Galdakao-modified supine Valdivia position. Patient demographics, stone characteristics, and surgical outcomes (including the need for a secondary puncture and stone-free rate) were recorded. Complications of blood transfusion requirement, bowel injury, and urosepsis were also recorded. Propensity score matching was used to adjust for potentially confounding factors, which included age, body mass index, ASA grade and stone complexity (size, density, location and Guy's stone score). RESULTS: 696 patients were identified who underwent either S-PCNL (n=532) or ECIRS (n=164). After propensity score matching, 157 patients in each group were matched (314 patients in total). ECIRS was associated with a significantly lower secondary puncture rate when compared to PCNL (3.2% vs 7.6%, p=<0.05). Stone free rate was higher in the ECIRS cohort compared to the S-PCNL cohort (90% vs 84%, p=<0.05). Complication rates between ECIRS and S-PCNL were similar (6.4% vs 9.6%, respectively, p=0.15). Blood transfusion rates were not significantly different with two blood transfusions being required in the PCNL group and no blood transfusions being required in the ECIRS group. CONCLUSIONS: This study demonstrates that the use of ECIRS can reduce the need for a secondary puncture when compared to S-PCNL. Higher stone free rate was observed in the ECIRS group whilst a comparable complication rate was maintained. This study suggests that ECIRS brings advantages in potentially reducing intraoperative renal trauma and therefore could reduce blood loss. As ECIRS continues to be used in favour of the traditional S-PCNL for select cases, larger comparative studies are needed to evaluate its potential advantages in surgical outcomes. Source of Funding: None to declare © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e481 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Thomas Fonseka More articles by this author Lara Logrado More articles by this author Filipa Dionisio More articles by this author Darrell Allen More articles by this author Anuj Goyal More articles by this author Gidon Ellis More articles by this author Rajesh Kucheria More articles by this author Antony Goode More articles by this author Dominic Yu More articles by this author Leye Ajayi More articles by this author Expand All Advertisement PDF downloadLoading ...