ECIRS (Endoscopic Combined Intrarenal Surgery) Versus Fluoroscopic-guided Renal Access during supine Percutaneous Nephrolithotomy (PCNL): A Comparative Study

Objective: To evaluate the intra- and post-operative outcomes of percutaneous renal access using either ECIRS (Endoscopic Combined Intrarenal Surgery) or fluoroscopic-guided renal access for supine percutaneous nephrolithotomy (PCNL). Methods: In our institute, over a 24-month period (April 2012 to March 2014), two surgeons performed a total of 68 PCNLs (not consecutive staghorn stone cases); 33 ECIRS and 35 fluoroscopically- guided access (FGA). All patient and calculi demographics were recorded, as well as intra-operative parameters and complication/secondary procedure rates. Results: We demonstrate that ECIRS offers rapid operating time (total procedure time 113 vs. 142 min, p<0.05), low complication rates (sepsis (0% vs. 5.8%), transfusion (0% vs. 8.6%) or bowel injury (0%)), with reduced in-patient stay (2 vs. 4 days, p<0.05) and high rates of stone clearance/residual fragments <4mm (3% vs. 25.7%, p<0.05) and low rate of secondary procedure (6.1% vs. 31.4%, p<0.05). Conclusion: ECIRS offers shorter operating times, with low complication rates, higher rates of stone clearance and a reduced requirement for secondary procedures in comparison to purely FGA. We envisage that this is due to a combination of quicker and more accurate needle placement, as well as the ability to perform concomitant FURS and laser stone fragmentation.