EAU 2019: Improving Safety and Efficacy of Endoscopic Combined IntraRenal Surgery with the Addition of Retrograde Flexible Ureteroscopy to Percutaneous Nephrolithotomy
In this proof of concept study, Dr. Cracco and colleagues performed 400 consecutive ECIRS procedures, standardized intra-and post-operatively step-by-step. Percutaneous access was obtained under ultrasound-guidance, fluoroscopy-guided +/- Endovision-controlled, using in 80% of cases one-step balloon dilation and in 95% of cases ballistic/ultrasound lithotripsy.
Preliminary semirigid ureteroscopy was performed in 83% of cases, subsequent flexible ureteroscopy in 60%, only flexible ureteroscopy in 10%. Endovision aid to fluoroscopy/ultrasound renal access was possible in 42% of cases. Retrograde fURS (for ureteral stone treatment, in situ lithotripsy, stone fragments retrieval in calyces parallel to the access tract, final combined exploration of all calyces) had an active role in 55% of cases. Looking at the stone-free rate, it was 88%, 93% after an early second percutaneous look during the same hospital stay. The overall complication rate was 7.8%. Mean fluoroscopy time of the Endovision cases was 3.2 minutes, versus 5.6 of the non-Endovision ECIRS.
Based on their results, the authors concluded that the ECIRS has been demonstrated to be truly favorable, both in terms of efficacy and safety. They hypothesized that the addition of retrograde fURS to PNL has a dual diagnostic and active role, allowing to tailor stone management on the dynamic anatomy of the collecting system and of urolithiasis, to optimize stone-free rates, and to reduce complications and radiation exposure.
Presented by: Cecilia Cracco, MD, PhD, Cottolengo Hospital, Department of Urology, Turin, Italy
Written by: Ekaterina Laukhtina, MD, Institute for Urology and Reproductive Health, Sechenov University, and Zhamshid Okhunov, MD, Twitter: @OkhunovZham, Department of Urology, University of California-Irvine at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.