title: Hydroperitoneum: A Rare Complication Performing Endoscopic Combined Intrarenal Surgery.
abstract: BACKGROUND
  Recently endoscopic combined intrarenal surgery (ECIRS) has been introduced as an innovative approach for the treatment of complex single, multiple, and staghorn urolithiasis, which reveals to be a viable alternative to standard percutaneous nephrolithotomy. Although considered to be a versatile, safe, and efficient endoscopic procedure, it is not free from complications. We would like to report two rare cases of hydroperitoneum that occurred during ECIRS and their management.
  
  
  METHODS
  Two female patients, respectively, of 75 and 41 years of age, underwent ECIRS procedure for the treatment of complex staghorn kidney urolithiasis, previously evaluated by noncontrast computed tomography (CT) scan. A combined retrograde-percutaneous access to the intrarenal collecting system, under fluoroscopic and ultrasound guidance with the additional assistance of Endovision technique, was performed. At the end of the procedures, both patients revealed a taut and globous abdomen, and a perioperative CT and ultrasonography revealed the presence of intraperitoneal liquid. Both patients were effectively treated with immediate positioning of abdominal drain with rapid improvement of the clinical presentation.
  
  
  CONCLUSIONS
  To our knowledge these are the first two cases of hydroperitoneum occurring during ECIRS and reported in the literature. An early detection of the complication and its prompt treatment revealed to be crucial to effectively prevent morbidity.
authors: Department of Urology, Vittorio Emanuele Hospital , Catania, Italy .
authors: Alfonso
authors: A
authors: Benincasa
authors: Department of Urology, Vittorio Emanuele Hospital , Catania, Italy .
authors: Federico
authors: F
authors: Nicolosi
authors: Department of Urology, Vittorio Emanuele Hospital , Catania, Italy .
authors: Mario
authors: M
authors: Falsaperla
authors: Department of Urology, Vittorio Emanuele Hospital , Catania, Italy .
authors: Alberto
authors: A
authors: Saita