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Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: A Retrospective Study.
J Endourol. 2016 10; 30(10):1056-1061.JE

Abstract

PURPOSE

The management of simultaneous renal and ureteral calculi usually require staged procedure or change of position from supine lithotomy for ureterorenoscopic lithotripsy to prone for conventional percutaneous nephrolithotomy (PCNL). We review our experience with endoscopic combined intrarenal surgery (ECIRS) in the management of this condition.

MATERIALS AND METHODS

A total of 43 patients with simultaneous renal and ureteral calculi underwent ECIRS in Galdakao-modified supine Valdivia (GMSV) position from June 2012 to March 2016. Relevant demographic and clinical data were analyzed retrospectively. Clinical outcomes such as stone-free rate, complications, and hospital stay were evaluated. Factors predicting stone-free rate were also evaluated.

RESULTS

The mean ureteral stone size was 9.79 ± 2.11 mm and the mean renal stone size was 28.0 ± 11.4 mm. All patients with ureteral calculus were stone free after first intervention. The overall immediate renal stone success rate was 81.4%, which increased to 97% after auxiliary procedure. The overall complication rate was 32.5% with majority of complications (86%) classified under Clavien grade 1 and 2. Two patients had Clavien grade 3 complication with no grade 4 or 5 complications. The mean operative room occupation time was 132.09 ± 35.3 minutes. The median hospital stay was 6 days (range: 2-31). On analyzing for risk factors, only the number of involved calices by stone was significantly associated with stone-free rate following ECIRS (p = 0.03).

CONCLUSION

ECIRS is a novel and excellent approach for the treatment of simultaneous renal and ureteral calculi with stone clearance and morbidity profile comparable to traditional prone PCNL. We believe that the advantage provided by this approach to the surgeon, patient, and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.

Authors+Show Affiliations

Department of Urology, JIPMER , Puducherry, India .Department of Urology, JIPMER , Puducherry, India .Department of Urology, JIPMER , Puducherry, India .Department of Urology, JIPMER , Puducherry, India .Department of Urology, JIPMER , Puducherry, India .Department of Urology, JIPMER , Puducherry, India .

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27479769

Citation

Manikandan, Ramanitharan, et al. "Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: a Retrospective Study." Journal of Endourology, vol. 30, no. 10, 2016, pp. 1056-1061.
Manikandan R, Mittal JK, Dorairajan LN, et al. Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: A Retrospective Study. J Endourol. 2016;30(10):1056-1061.
Manikandan, R., Mittal, J. K., Dorairajan, L. N., Mishra, A. K., Sreerag, K. S., & Verma, A. (2016). Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: A Retrospective Study. Journal of Endourology, 30(10), 1056-1061.
Manikandan R, et al. Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: a Retrospective Study. J Endourol. 2016;30(10):1056-1061. PubMed PMID: 27479769.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: A Retrospective Study. AU - Manikandan,Ramanitharan, AU - Mittal,Jayesh Kumar, AU - Dorairajan,Lalgudi Narayanan, AU - Mishra,Amit Kumar, AU - Sreerag,Kodakkatil Sreenivasan, AU - Verma,Anil, Y1 - 2016/09/13/ PY - 2016/8/2/pubmed PY - 2017/8/24/medline PY - 2016/8/2/entrez KW - ECIRS KW - GMSV position KW - complex urolithiasis KW - pneumatic lithotripsy KW - supine PCNL KW - ultrasound guided renal puncture SP - 1056 EP - 1061 JF - Journal of endourology JO - J Endourol VL - 30 IS - 10 N2 - PURPOSE: The management of simultaneous renal and ureteral calculi usually require staged procedure or change of position from supine lithotomy for ureterorenoscopic lithotripsy to prone for conventional percutaneous nephrolithotomy (PCNL). We review our experience with endoscopic combined intrarenal surgery (ECIRS) in the management of this condition. MATERIALS AND METHODS: A total of 43 patients with simultaneous renal and ureteral calculi underwent ECIRS in Galdakao-modified supine Valdivia (GMSV) position from June 2012 to March 2016. Relevant demographic and clinical data were analyzed retrospectively. Clinical outcomes such as stone-free rate, complications, and hospital stay were evaluated. Factors predicting stone-free rate were also evaluated. RESULTS: The mean ureteral stone size was 9.79 ± 2.11 mm and the mean renal stone size was 28.0 ± 11.4 mm. All patients with ureteral calculus were stone free after first intervention. The overall immediate renal stone success rate was 81.4%, which increased to 97% after auxiliary procedure. The overall complication rate was 32.5% with majority of complications (86%) classified under Clavien grade 1 and 2. Two patients had Clavien grade 3 complication with no grade 4 or 5 complications. The mean operative room occupation time was 132.09 ± 35.3 minutes. The median hospital stay was 6 days (range: 2-31). On analyzing for risk factors, only the number of involved calices by stone was significantly associated with stone-free rate following ECIRS (p = 0.03). CONCLUSION: ECIRS is a novel and excellent approach for the treatment of simultaneous renal and ureteral calculi with stone clearance and morbidity profile comparable to traditional prone PCNL. We believe that the advantage provided by this approach to the surgeon, patient, and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/27479769/Endoscopic_Combined_Intrarenal_Surgery_for_Simultaneous_Renal_and_Ureteral_Stones:_A_Retrospective_Study_ L2 - https://www.liebertpub.com/doi/10.1089/end.2016.0329?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -