title: Efficacy of endoscopic combined intrarenal surgery in the prone split-leg position for staghorn calculi.
abstract: Abstract Purpose: To evaluate the efficacy of endoscopic combined intrarenal surgery (ECIRS) using retrograde flexible ureteroscopy and miniature percutaneous nephrolithotomy (PNL) for the treatment of patients with staghorn calculi in the prone split-leg position.
  
  
  METHODS
  We retrospectively reviewed the records of 42 patients with staghorn calculi (45.8±3.2 mm) who underwent ECIRS using retrograde flexible ureteroscopy and miniature PNL in the prone split-leg position for the treatment of staghorn calculi in our center between December 2010 and August 2013. A flexible ureteroscope with a laser fiber was inserted through a ureteral access sheath, and lithoclast lithotripsy was performed through a mini-percutaneous tract. Both procedures were performed simultaneously by two urologists. Surgical parameters, including surgical time, stone-free (SF) rates, modified Clavien complication grades, and risk factors for residual stones, were analyzed.
  
  
  RESULTS
  Fifteen patients (35.7%) had complete staghorn calculi. Among the 42 staghorn calculi treated, 23 had 0 to 5 stone branches, 14 had 6 to 10 stone branches, and 5 had ≥11 stone branches. All procedures were performed successfully using a single lithotripsy tract with the patient in the prone split-leg position. The mean surgical time was 143.2±9.2 minutes. The initial SF rate was 71.4%, and the final SF rate was 83.3% after further treatment. One patient required a blood transfusion (2.4%), but no patient experienced a ≥3 Clavien grade complication. Risk factors for residual stones were stone size, stone surface area, complete staghorn calculi, and the number of stone branches.
  
  
  CONCLUSIONS
  ECIRS for staghorn calculi in the prone split-leg position is a safe, efficient, and versatile method for the effective management of staghorn calculi without the creation of multiple percutaneous tracts.
authors: 1 Department of Urology, Toyota Kosei Hospital , Toyota, Japan .
authors: Shuzo
authors: S
authors: Hamamoto
authors: Takahiro
authors: T
authors: Yasui
authors: Atsushi
authors: A
authors: Okada
authors: Satoshi
authors: S
authors: Koiwa
authors: Kazumi
authors: K
authors: Taguchi
authors: Yasunori
authors: Y
authors: Itoh
authors: Noriyasu
authors: N
authors: Kawai
authors: Yoshihiro
authors: Y
authors: Hashimoto
authors: Keiichi
authors: K
authors: Tozawa
authors: Kenjiro
authors: K
authors: Kohri
mesh_terms: D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D017602:Lithotripsy, Laser / Q000379:methods; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D056888:Patient Positioning / Q000379:methods; D016684:Prone Position; D012189:Retrospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*