Endoscopic combined intrarenal surgery (ECIRS) versus supine percutaneous nephrolithotomy (S-PCNL): a propensity score matched study of surgical outcomes and complications.

Purpose: Endoscopic Combined Intrarenal Surgery (ECIRS) has transformed the management of complex renal stones, offering potential advantages over conventional Percutaneous Nephrolithotomy (PCNL), including reduced need for secondary punctures and improved stone-free rates (SFR). This study aimed to compare surgical outcomes and complications between ECIRS and Supine PCNL (S-PCNL).

Methods: Data was prospectively collected from all consecutive patients treated with ECIRS or S-PCNL at a UK tertiary centre from 2008 to 2024. Surgical outcomes, complications, transfusion rates, and hospital stay were recorded. A 1:1 propensity score matching (PSM) method was used to minimize differences in baseline characteristics. The primary outcome was secondary puncture rate; secondary outcomes included SFR, complication rates, operative time, transfusion rate, and hospital stay.

Results: A total of 704 patients were included, with 186 (26%) undergoing ECIRS. After PSM, 176 matched pairs were analysed. ECIRS showed a significantly lower secondary puncture rate (2% vs. 7%, p = 0.01) and higher SFR (90% vs. 81%, p = 0.01). There were no significant differences in overall (16% vs. 14%, p = 0.7) or major complications (6% vs. 4.5%, p = 0.8), or in transfusion rates (0.6% vs. 1.1%, p = 0.7). ECIRS had a longer median operative time [72 vs. 65 min, p = 0.03], while S-PCNL was associated with a longer hospital stay [3 vs. 2 days, p = 0.02].

Conclusions: ECIRS is a safe and effective technique for managing complex renal stones. The technique is associated with higher stone free rate and reduced need for secondary puncture compared to S-PCNL.