The use of endoscopic combined intrarenal surgery in the treatment of nephrolithiasis
DOI:
https://doi.org/10.14739/2310-1210.2022.6.259771Keywords:
nephrolithiasis, kidney stones, endoscopic combined intrarenal surgery, percutaneous nephrolithotomy, retrograde intrarenal surgery, robotic surgery, endoscopyAbstract
Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment.
Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods.
Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety.
Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy.
Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive.
References
Roberson, D., Sperling, C., Shah, A., & Ziemba, J. (2020). Economic Considerations in the Management of Nephrolithiasis. Current Urology Reports, 21(5), 18. https://doi.org/10.1007/s11934-020-00971-6
Mykoniatis, I., Sarafidis, P., Memmos, D., Anastasiadis, A., Dimitriadis, G., & Hatzichristou, D. (2020). Are endourological procedures for nephrolithiasis treatment associated with renal injury? A review of potential mechanisms and novel diagnostic indexes. Clinical Kidney Journal, 13(4), 531-541. https://doi.org/10.1093/ckj/sfaa020
Shoag, J., Tasian, G., Goldfarb, D., & Eisner, B. (2015). The New Epidemiology of Nephrolithiasis. Advances In Chronic Kidney Disease, 22(4), 273-278. https://doi.org/10.1053/j.ackd.2015.04.004
López, M., & Hoppe, B. (2010). History, epidemiology and regional diversities of urolithiasis. Pediatric Nephrology, 25(1), 49-59. https://doi.org/10.1007/s00467-008-0960-5
Böhm, W., Holstiege, J., Wenzel, S., Fahlenkamp, D., & Berg, W. (2019). Die Nephrolithiasis im komplexen Metaphylaxesystem heute. Der Urologe, 58(5), 535-542. https://doi.org/10.1007/s00120-019-0927-0
Ang, A., Sharma, A., & Sharma, A. (2020). Nephrolithiasis: Approach to Diagnosis and Management. The Indian Journal Of Pediatrics, 87(9), 716-725. https://doi.org/10.1007/s12098-020-03424-7
Cicerello, E., Mangano, M., Cova, G., & Ciaccia, M. (2020). Changing in gender prevalence of nephrolithiasis. Urologia Journal, 88(2), 90-93. https://doi.org/10.1177/0391560320966206
Kittanamongkolchai, W., Vaughan, L. E., Enders, F. T., Dhondup, T., Mehta, R. A., Krambeck, A. E., McCollough, C. H., Vrtiska, T. J., Lieske, J. C., & Rule, A. D. (2018). The Changing Incidence and Presentation of Urinary Stones Over 3 Decades. Mayo Clinic proceedings, 93(3), 291-299. https://doi.org/10.1016/j.mayocp.2017.11.018
Tundo, G., Khaleel, S., & Pais, V. M., Jr (2018). Gender Equivalence in the Prevalence of Nephrolithiasis among Adults Younger than 50 Years in the United States. The Journal of urology, 200(6), 1273-1277. https://doi.org/10.1016/j.juro.2018.07.048
Ferraro, P. M., Taylor, E. N., Gambaro, G., & Curhan, G. C. (2017). Dietary and Lifestyle Risk Factors Associated with Incident Kidney Stones in Men and Women. The Journal of urology, 198(4), 858-863. https://doi.org/10.1016/j.juro.2017.03.124
Sorokin, I., Mamoulakis, C., Miyazawa, K., Rodgers, A., Talati, J., & Lotan, Y. (2017). Epidemiology of stone disease across the world. World journal of urology, 35(9), 1301-1320. https://doi.org/10.1007/s00345-017-2008-6
Raheem, O. A., Khandwala, Y. S., Sur, R. L., Ghani, K. R., & Denstedt, J. D. (2017). Burden of Urolithiasis: Trends in Prevalence, Treatments, and Costs. European urology focus, 3(1), 18-26. https://doi.org/10.1016/j.euf.2017.04.001
EAU. (2022). Urolithiasis. Guidelines. https://uroweb.org/guidelines/urolithiasis/chapter/citation-information
Assimos, D., Krambeck, A., Miller, N. L., Monga, M., Murad, M. H., Nelson, C. P., Pace, K. T., Pais, V. M., Jr, Pearle, M. S., Preminger, G. M., Razvi, H., Shah, O., & Matlaga, B. R. (2016). Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. The Journal of urology, 196(4), 1153-1160. https://doi.org/10.1016/j.juro.2016.05.090
Tsai, S., Chung, H., Tseng, P., Wu, Y., Tu, Y., Hsu, C., & Lei, W. (2020). Comparison of the efficacy and safety of shockwave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy, and minimally invasive percutaneous nephrolithotomy for lower-pole renal stones. Medicine, 99(10), e19403. https://doi.org/10.1097/md.0000000000019403
Diri, A., & Diri, B. (2018). Management of staghorn renal stones. Renal Failure, 40(1), 357-362. https://doi.org/10.1080/0886022x.2018.1459306
Jung, H. D., Kim, J. C., Ahn, H. K., Kwon, J. H., Han, K., Han, W. K., Kim, M. D., & Lee, J. Y. (2018). Real-time simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: Washout mechanism and transport technique. Investigative and clinical urology, 59(5), 348-354. https://doi.org/10.4111/icu.2018.59.5.348
Kellett, M., Wickham, J., & Payne, S. (1985). Combined retrograde and antegrade manipulations for percutaneous nephrolithotomy of ureteric calculi: "Push-pull" technique. Urology, 25(4), 391-392. https://doi.org/10.1016/0090-4295(85)90496-0
Axelsson, T. A., Cracco, C., Desai, M., Hasan, M. N., Knoll, T., Montanari, E., Pérez-Fentes, D., Straub, M., Thomas, K., Williams, J. C., Jr, Brehmer, M., & Osther, P. (2021). Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy. World journal of urology, 39(6), 1663-1670. https://doi.org/10.1007/s00345-020-03383-w
Ibarluzea, G., Scoffone, C. M., Cracco, C. M., Poggio, M., Porpiglia, F., Terrone, C., Astobieta, A., Camargo, I., Gamarra, M., Tempia, A., Valdivia Uria, J. G., & Scarpa, R. M. (2007). Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU international, 100(1), 233-236. https://doi.org/10.1111/j.1464-410X.2007.06960.x
Scoffone, C., & Cracco, C. (2017). Invited review: the tale of ECIRS (Endoscopic Combined IntraRenal Surgery) in the Galdakao-modified supine Valdivia position. Urolithiasis, 46(1), 115-123. https://doi.org/10.1007/s00240-017-1015-9
Scoffone, C., Cracco, C., Cossu, M., Grande, S., Poggio, M., & Scarpa, R. (2008). Endoscopic Combined Intrarenal Surgery in Galdakao-Modified Supine Valdivia Position: A New Standard for Percutaneous Nephrolithotomy?. European Urology, 54(6), 1393-1403. https://doi.org/10.1016/j.eururo.2008.07.073
Scoffone, C., & Cracco, C. (2017). Invited review: the tale of ECIRS (Endoscopic Combined IntraRenal Surgery) in the Galdakao-modified supine Valdivia position. Urolithiasis, 46(1), 115-123. https://doi.org/10.1007/s00240-017-1015-9
Gücük, A., Kemahlı, E., Üyetürk, U., Tuygun, C., Yıldız, M., & Metin, A. (2013). Routine Flexible Nephroscopy for Percutaneous Nephrolithotomy for Renal Stones with Low Density: A Prospective, Randomized Study. Journal of Urology, 190(1), 144-148. https://doi.org/10.1016/j.juro.2013.01.009
Gökce, M. İ., Gülpinar, O., Ibiş, A., Karaburun, M., Kubilay, E., & Süer, E. (2019). Retrograde vs. antegrade fl exible nephroscopy for detection of residual fragments following PNL: A prospective study with computerized tomography control. International braz j urol, 45(3), 581-587. https://doi.org/10.1590/S1677-5538.IBJU.2018.0695
Martin, C. J., McAdams, S. B., Abdul-Muhsin, H., Lim, V. M., Nunez-Nateras, R., Tyson, M. D., & Humphreys, M. R. (2017). The Economic Implications of a Reusable Flexible Digital Ureteroscope: A Cost-Benefit Analysis. The Journal of urology, 197(3 Pt 1), 730-735. https://doi.org/10.1016/j.juro.2016.09.085
Birowo, P., Raharja, P., Atmoko, W., & Rasyid, N. (2021). X-Ray-Free Endoscopic Combined Intrarenal Surgery for Complex Proximal Ureteral Stone: A Case Report. Research and reports in urology, 13, 121-125. https://doi.org/10.2147/RRU.S299707
Manikandan, R., Mittal, J., Dorairajan, L., Mishra, A., Sreerag, K., & Verma, A. (2016). Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: A Retrospective Study. Journal of Endourology, 30(10), 1056-1061. https://doi.org/10.1089/end.2016.0329
Rosette, J., Assimos, D., Desai, M., Gutierrez, J., Lingeman, J., Scarpa, R., & Tefekli, A. (2011). The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: Indications, Complications, and Outcomes in 5803 Patients. Journal of Endourology, 25(1), 11-17. https://doi.org/10.1089/end.2010.0424
Sahalevych, А., Sergiychuk, R., Ozhohin, V., Vozianov, O., Khrapchuk, A., Dubovyi, Y., & Frolov, O. (2021). Mini-percutaneous nephrolithotomy in surgery of nephrolithiasis. Ukrainian Journal of Nephrology and Dialysis, (3), 44-52. https://doi.org/10.31450/ukrjnd.3(71).2021.06
Pawar, P., Arora, A., Tamhankar, A., Sawant, A., Mundhe, S., & Patil, S. (2019). Predictors for severe hemorrhage requiring angioembolization post percutaneous nephrolithotomy: A single-center experience over 3 years. Urology Annals, 11(2), 180. https://doi.org/10.4103/ua.ua_75_18
Valdivia, J., Scarpa, R., Duvdevani, M., Gross, A., Nadler, R., Nutahara, K., & de la Rosette, on behalf of the CRO, J. (2011). Supine Versus Prone Position During Percutaneous Nephrolithotomy: A Report from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. Journal of Endourology, 25(10), 1619-1625. https://doi.org/10.1089/end.2011.0110
Usui, K., Komeya, M., Taguri, M., Kataoka, K., Asai, T., Ogawa, T., Yao, M., & Matsuzaki, J. (2020). Minimally invasive versus standard endoscopic combined intrarenal surgery for renal stones: a retrospective pilot study analysis. International urology and nephrology, 52(7), 1219-1225. https://doi.org/10.1007/s11255-020-02433-x
Wen, J., Xu, G., Du, C., & Wang, B. (2016). Minimally invasive percutaneous nephrolithotomy versus endoscopic combined intrarenal surgery with flexible ureteroscope for partial staghorn calculi: A randomised controlled trial. International Journal of Surgery, 28, 22-27. https://doi.org/10.1016/j.ijsu.2016.02.056
Huang, Y. L., Li, Z. H., Liu, C., Han, J. L., Li, K. Q., Huang, L., Yu, H., & Xu, K. W. (2021). Comparison of multi-tract PCNL and single-tract ECIRS in semisupine-lithotomy position for staghorn renal calculi. Zhonghua yi xue za zhi, 101(38), 3121-3126. https://doi.org/10.3760/cma.j.cn112137-20210223-00473
Zhao, F., Li, J., Tang, L., & Li, C. (2020). A comparative study of endoscopic combined intrarenal surgery (ECIRS) in the galdakao-modified supine valdivia (GMSV) position and minimally invasive percutaneous nephrolithotomy for complex nephrolithiasis: a retrospective single-center study. Urolithiasis, 49(2), 161-166. https://doi.org/10.1007/s00240-020-01207-5
Gómez-Regalado, F., Manzo, B., Figueroa-Garcia, A., Sanchez-Lopez, H., Basulto-Martinez, M., Cracco, C., & Scoffone, C. (2020). Efficacy of the Endoscopic Combined Intrarenal Surgery for the Treatment of a Staghorn Calculus in Crossed Fused Renal Ectopia. Journal of Endourology Case Reports, 6(3), 205-208. https://doi.org/10.1089/cren.2019.0181
Ganpule, A., Naveen Kumar Reddy, M., Sudharsan, S., Shah, S., Sabnis, R., & Desai, M. (2020). Multitract percutaneous nephrolithotomy in staghorn calculus. Asian Journal of Urology, 7(2), 94-101. https://doi.org/10.1016/j.ajur.2019.10.001
Klein, I., & Gutiérrez-Aceves, J. (2020). Preoperative imaging in staghorn calculi, planning and decision making in management of staghorn calculi. Asian Journal of Urology, 7(2), 87-93. https://doi.org/10.1016/j.ajur.2019.07.002
Blum, K., Parkhomenko, E., Thai, J., Tran, T., & Gupta, M. (2018). A contemporary lower pole approach for complete staghorn calculi: outcomes and efficacy. World Journal of Urology, 36(9), 1461-1467. https://doi.org/10.1007/s00345-018-2284-9
Khadgi, S., EL-Nahas, A., Darrad, M., & AL-Terki, A. (2019). Safety and efficacy of a single middle calyx access (MCA) in mini-PCNL. Urolithiasis, 48(6), 541-546. https://doi.org/10.1007/s00240-019-01176-4
Liu, Y. H., Jhou, H. J., Chou, M. H., Wu, S. T., Cha, T. L., Yu, D. S., Sun, G. H., Chen, P. H., & Meng, E. (2022). Endoscopic Combined Intrarenal Surgery Versus Percutaneous Nephrolithotomy for Complex Renal Stones: A Systematic Review and Meta-Analysis. Journal of personalized medicine, 12(4), 532. https://doi.org/10.3390/jpm12040532
Proietti, S., de la Rosette, J., Eisner, B., Gaboardi, F., Fiori, C., Kinzikeeva, E., Luciani, L., Miano, R., Porpiglia, F., Rosso, M., Sofer, M., Traxer, O., & Giusti, G. (2017). Bilateral endoscopic surgery for renal stones: a systematic review of the literature. Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 69(5), 432-445. https://doi.org/10.23736/S0393-2249.17.02831-4
Geraghty, R., Jones, P., & Somani, B. (2019). Simultaneous Bilateral Endoscopic Surgery (SBES) for Bilateral Urolithiasis: the Future? Evidence from a Systematic Review. Current Urology Reports, 20(3). https://doi.org/10.1007/s11934-019-0877-5
Giusti, G., Proietti, S., Rodríguez-Socarrás, M. E., Eisner, B. H., Saitta, G., Mantica, G., Villa, L., Salonia, A., Montorsi, F., & Gaboardi, F. (2018). Simultaneous Bilateral Endoscopic Surgery (SBES) for Patients with Bilateral Upper Tract Urolithiasis: Technique and Outcomes. European urology, 74(6), 810-815. https://doi.org/10.1016/j.eururo.2018.06.034
Angerri, O., Mayordomo, O., Kanashiro, A. K., Millan-Rodriguez, F., Sanchez-Martin, F. M., Cho, S. Y., Schreter, E., Sofer, M., Bin-Hamri, S., Alasker, A., Tanidir, Y., Sener, T. E., Kalidonis, P., Palou-Redorta, J., & Emiliani, E. (2019). Simultaneous and synchronous bilateral endoscopic treatment of urolithiasis: a multicentric study. Central European journal of urology, 72(2), 178-182. https://doi.org/10.5173/ceju.2019.1862
Proietti, S., Pavia, M. P., Rico, L., Basulto-Martinez, M., Yeow, Y., Contreras, P., Galosi, A., Gaboardi, F., & Giusti, G. (2022). Simultaneous Bilateral Endoscopic Surgery (SBES): Is It Ready for Prime Time?. Journal of endourology, 36(9), 1155-1160. https://doi.org/10.1089/end.2022.0013
Hamamoto, S., Yasui, T., Okada, A., Taguchi, K., Kawai, N., Ando, R., Mizuno, K., Kubota, Y., Kamiya, H., Tozawa, K., & Kohri, K. (2014). Endoscopic combined intrarenal surgery for large calculi: simultaneous use of flexible ureteroscopy and mini-percutaneous nephrolithotomy overcomes the disadvantageous of percutaneous nephrolithotomy monotherapy. Journal of endourology, 28(1), 28-33. https://doi.org/10.1089/end.2013.0361
Biligere, S., Heng, C. T., Cracco, C., Mangat, R., Ong, C. S., Thandapani, K., Inoue, T., Sarica, K., Sabnis, R. B., Desai, M., Scoffone, C., & Gauhar, V. (2021). Tips and Tricks to Improve Ergonomics, Efficacy, Versatility, and Overcome Limitations of Micro Percutaneous Nephrolithotomy. Frontiers in surgery, 8, 668928. https://doi.org/10.3389/fsurg.2021.668928
Hamamoto, S., Yasui, T., Okada, A., Takeuchi, M., Taguchi, K., Shibamoto, Y., Iwase, Y., Kawai, N., Tozawa, K., & Kohri, K. (2014). Developments in the technique of endoscopic combined intrarenal surgery in the prone split-leg position. Urology, 84(3), 565-570. https://doi.org/10.1016/j.urology.2014.04.020
Taguchi, K., Yamashita, S., Hamamoto, S., Deguchi, R., Kawase, K., Okada, T., Kato, T., Ando, R., Okada, A., Kohjimoto, Y., Hara, I., & Yasui, T. (2021). Ureteroscopy-assisted puncture for ultrasonography-guided renal access significantly improves overall treatment outcomes in endoscopic combined intrarenal surgery. International journal of urology, 28(9), 913-919. https://doi.org/10.1111/iju.14603
Kang, N., Jiang, Y. H., Jiang, Y. G., Wu, L. Y., Zhang, J. Q., Niu, Y. N., & Zhang, J. H. (2020). [Endoscopic combined ultrasound-guided access vs. ultrasound-guided access in endoscopic combined intrarenal surgery]. Journal of Peking University. Health sciences, 52(4), 692-696. https://doi.org/10.19723/j.issn.1671-167X.2020.04.018
Lima, E., Rodrigues, P. L., Mota, P., Carvalho, N., Dias, E., Correia-Pinto, J., Autorino, R., & Vilaça, J. L. (2017). Ureteroscopy-assisted Percutaneous Kidney Access Made Easy: First Clinical Experience with a Novel Navigation System Using Electromagnetic Guidance (IDEAL Stage 1). European urology, 72(4), 610-616. https://doi.org/10.1016/j.eururo.2017.03.011
Gomes-Fonseca, J., Veloso, F., Queirós, S., Morais, P., Pinho, A., Fonseca, J. C., Correia-Pinto, J., Lima, E., & Vilaça, J. L. (2020). Technical Note: Assessment of electromagnetic tracking systems in a surgical environment using ultrasonography and ureteroscopy instruments for percutaneous renal access. Medical physics, 47(1), 19-26. https://doi.org/10.1002/mp.13879
Uribe, C., Osorio, H., Benavides, J., Martinez, C., Valley, Z., & Kaler, K. (2019). A New Technique for Percutaneous Nephrolithotomy Using Retrograde Ureteroscopy and Laser Fiber to Achieve Percutaneous Nephrostomy Access: The Initial Case Report. Journal of Endourology Case Reports, 5(3), 131-136. https://doi.org/10.1089/cren.2018.0079
Kaler, K., Parkhomenko, E., Okunohov, Z., Patel, R., Landman, J., Clayman, R., & Uribe, C. (2018). Ureteroscopic holmium laser-assisted retrograde nephrostomy access: a novel approach to percutaneous stone removal. World Journal of Urology, 36(6), 963-969. https://doi.org/10.1007/s00345-018-2223-9
Taguchi, K., Hamamoto, S., Kato, T., Iwatsuki, S., Etani, T., Okada, A., & Yasui, T. (2020). Robot‐assisted fluoroscopy‐guided renal puncture for endoscopic combined intrarenal surgery: a pilot single‐centre clinical trial. BJU International, 127(3), 307-310. https://doi.org/10.1111/bju.15291
Tokatli, Z., Ibis, M., & Sarica, K. (2022). Robot-Assisted Mini-Endoscopic Combined Intrarenal Surgery for Complex and Multiple Calculi: What Are the Real Advantages?. Journal of Laparoendoscopic &Amp; Advanced Surgical Techniques. https://doi.org/10.1089/lap.2022.0124
Veys, R., Verpoort, P., Van Haute, C., Wang, Z., Chi, T., & Tailly, T. (2019). Thiel‐embalmed cadavers as a novel training model for ultrasound‐guided supine endoscopic combined intrarenal surgery. BJU International, 125(4), 579-585. https://doi.org/10.1111/bju.14954
Cracco, C., & Scoffone, C. (2020). Endoscopic combined intrarenal surgery (ECIRS) - Tips and tricks to improve outcomes: A systematic review. Türk Üroloji Dergisi/Turkish Journal of Urology, 46(Supp1), S46-S57. https://doi.org/10.5152/tud.2020.20282
Keller, E., De Coninck, V., Doizi, S., & Traxer, O. (2020). The role of ureteroscopy for treatment of staghorn calculi: A systematic review. Asian Journal of Urology, 7(2), 110-115. https://doi.org/10.1016/j.ajur.2019.10.012
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. 
