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Comparative Study
. 2025 May 6;43(1):275.
doi: 10.1007/s00345-025-05455-1.

Endoscopic Combined Intra Renal Surgery versus Percutanous Nephrolithotomy: utcomes of a matched case-control analyis

Rodrigo Perrella  1   2 , Fabio Carvalho Vicentini  3   4 , Matheus Marques P Neto  5 , Daniel Beltrame Ferreira  6 , Fabio C M Torricelli  3 , Giovani S Marchini  3 , Alexandre Danilovic  3 , Carlos A Batagello  3 , Anderson B Pellanda  3 , Henrique Cunha Vieira  5 , Rafael T Yadoya  5 , Priscila Kuriki Vieira Mota  6 , Valter Dell Acqua Cassão  6 , Joaquim Francisco de Almeida Claro  6 , William C Nahas  3 , Eduardo Mazzucchi  3
Affiliations
Comparative Study

Endoscopic Combined Intra Renal Surgery versus Percutanous Nephrolithotomy: utcomes of a matched case-control analyis

Rodrigo Perrella et al. World J Urol. .

Abstract

Purpose: To compare the efficacy and safety outcomes of Endoscopic Combined Intrarenal Surgery (ECIRS) and Percutaneous Nephrolithotomy (PCNL) in the treatment of kidney stones.

Methods: A retrospective matched case-control study was conducted from July 2022 to January 2024, utilizing prospectively collected kidney stone databases from two centers. Patients who underwent PCNL or ECIRS for kidney stone treatment were included. Cases and controls were matched based on stone complexity, using the Guy's Stone Score (GSS) in a 1:2 ratio. Computed tomography (CT) was performed 90 days postoperatively to assess the stone free rate, defined as the absence of residual fragments. The analyzed variables included age, sex, body mass index (BMI), ASA score, comorbidities, stone diameter, GSS, operative time, number of accesses, blood transfusions, hemoglobin drop, hospital stay, stone free rate, and complication rates. Statistical analysis was performed using the Student's t-test for continuous variables and the Chi-square or Fisher's exact test for categorical variables, with significance set at p < 0.05.

Results: A total of 165 patients were included (55 in the ECIRS group and 110 in the PCNL group). Demographic characteristics were comparable between groups. ECIRS demonstrated a higher stone-free rate (81.8% vs. 56.4%; p = 0.001), particularly in complex cases (GSS 3 and 4) (79.2% vs. 41.7%; p = 0.003). There was no significant difference in complication rates between the two groups (21.8% vs. 26.4%; p = 0.607).

Conclusion: ECIRS is an effective treatment, particularly for large and complex kidney stones, offering higher success rates compared to PCNL, with similar complication rates.

Keywords: Computed tomography; Endoscopic combined intra renal surgery; Kidney stone; Percutaneous nephrolithotomy.

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Conflict of interest statement

Declarations. Ethical approval: All procedures performed in the study were in accordance with the ethical standards of the local research committee and with the 1964 Helsinki Declaration and its later amendments. Informed consent: Informed consent was obtained from all patients. Competing interests: The authors declare no competing interests.

References

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