OBJECTIVE: This study aimed at assessing current efficacy and safety of endoscopic combined intrarenal surgery (ECIRS) for the treatment of large and/or complex urolithiasis and identifying relevant tips and tricks able to improve its outcomes, mainly deriving from the adjunct of retrograde flexible ureteroscopy to the traditional antegrade approach of percutaneous nephrolithotomy (PNL). MATERIAL AND METHODS: A systematic review was conducted using relevant databases (Ovid Medline, PubMed, Scopus, and Web of Sciences), employing "ECIRS" as the search term in all cases, and then adding "endoscopic combined intrarenal surgery" and "flexible ureteroscopy AND percutaneous nephrolithotomy" as search terms for PubMed and Scopus. Original articles and systematic reviews were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Additionally, the reference lists of the selected publications were checked manually. RESULTS: A total of 14 studies were selected for analysis: two systematic reviews, one randomized controlled trial, five nonrandomized comparative studies, three prospective case series, and three retrospective case series. ECIRS achieves high stone-free rates and rather low/low Clavien-Dindo grade complication rates, confirming the role of retrograde ureteroscopy in the maximization of its efficacy and safety. A narrative synthesis of the most recognized tips and tricks of ECIRS is provided. CONCLUSION: The contribution of retrograde flexible ureteroscopy during PNL is essential. It plays a dual role, both diagnostic and active, allowing tailoring of the procedure to the patient, urolithiasis, and anatomy of the collecting system and optimization of the PNL efficacy and safety. This is ECIRS: an updated, complete, and versatile version of PNL.
OBJECTIVE: This study aimed at assessing current efficacy and safety of endoscopic combined intrarenal surgery (ECIRS) for the treatment of large and/or complex urolithiasis and identifying relevant tips and tricks able to improve its outcomes, mainly deriving from the adjunct of retrograde flexible ureteroscopy to the traditional antegrade approach of percutaneous nephrolithotomy (PNL). MATERIAL AND METHODS: A systematic review was conducted using relevant databases (Ovid Medline, PubMed, Scopus, and Web of Sciences), employing "ECIRS" as the search term in all cases, and then adding "endoscopic combined intrarenal surgery" and "flexible ureteroscopy AND percutaneous nephrolithotomy" as search terms for PubMed and Scopus. Original articles and systematic reviews were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Additionally, the reference lists of the selected publications were checked manually. RESULTS: A total of 14 studies were selected for analysis: two systematic reviews, one randomized controlled trial, five nonrandomized comparative studies, three prospective case series, and three retrospective case series. ECIRS achieves high stone-free rates and rather low/low Clavien-Dindo grade complication rates, confirming the role of retrograde ureteroscopy in the maximization of its efficacy and safety. A narrative synthesis of the most recognized tips and tricks of ECIRS is provided. CONCLUSION: The contribution of retrograde flexible ureteroscopy during PNL is essential. It plays a dual role, both diagnostic and active, allowing tailoring of the procedure to the patient, urolithiasis, and anatomy of the collecting system and optimization of the PNL efficacy and safety. This is ECIRS: an updated, complete, and versatile version of PNL.
Authors: Ahmed R el-Nahas; Ibrahim Eraky; Ahmed A Shokeir; Ahmed M Shoma; Ahmed M el-Assmy; Nasr A el-Tabey; Shady Soliman; Ahmed M Elshal; Hamdy A el-Kappany; Mahmoud R el-Kenawy Journal: Urology Date: 2012-04-01 Impact factor: 2.649
Authors: Seth K Bechis; Daniel S Han; Joel E Abbott; Daniel D Holst; Amy Alagh; Thomas DiPina; Roger L Sur Journal: J Endourol Date: 2018-04-10 Impact factor: 2.942
Authors: Diego Santillán; Jordan Ceferino Scherñuk Schroh; Patricia Andrea Gutierrez; Franco Thomas; Federico Ignacio Tirapegui; Juan Moldes; Christian Cristallo; Mariano Sebastian González Journal: Afr J Urol Date: 2021-10-26
Authors: Vineet Gauhar; Daniele Castellani; Cecilia Maria Cracco; Cesare Marco Scoffone; Ee Jean Lim; Emanuele Rubilotta; Eugenio Pretore; Giacomo Maria Pirola; Martina Maggi; Patrick Rice; Vinson Wai-Shun Chan; Jeremy Yuen-Chun Teoh; Chin-Tiong Heng; Bhaskar Kumar Somani; Maria Pia Pavia Journal: Cent European J Urol Date: 2022-04-29