title: Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: A Retrospective Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.affiliation: Department of Urology, JIPMER , Puducherry, India .
authors.forename: Ramanitharan
authors.initials: R
authors.lastname: Manikandan
authors.affiliation: Department of Urology, JIPMER , Puducherry, India .
authors.forename: Jayesh Kumar
authors.initials: JK
authors.lastname: Mittal
authors.affiliation: Department of Urology, JIPMER , Puducherry, India .
authors.forename: Lalgudi Narayanan
authors.initials: LN
authors.lastname: Dorairajan
authors.affiliation: Department of Urology, JIPMER , Puducherry, India .
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Mishra
authors.affiliation: Department of Urology, JIPMER , Puducherry, India .
authors.forename: Kodakkatil Sreenivasan
authors.initials: KS
authors.lastname: Sreerag
authors.affiliation: Department of Urology, JIPMER , Puducherry, India .
authors.forename: Anil
authors.initials: A
authors.lastname: Verma
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D016684:Prone Position; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000601:surgery; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*
keywords: ECIRS; GMSV position; complex urolithiasis; pneumatic lithotripsy; supine PCNL; ultrasound guided renal puncture