MP29-02: Endoscopic combined intrarenal surgery (ECIRS) is associated with a lower secondary puncture rate when compared to standard supine percutaneous nephrolithotomy (S-PCNL): results from a propensity score matched analysis
Saturday, May 4, 2024 9:30 AM to 11:30 AM · 2 hr. (US/Central)
302B
Abstract
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Full Abstract and Figures
Author Block
Thomas Fonseka*, Lara Logrado, Filipa Dionisio, Darrell Allen, Anuj Goyal, Gidon Ellis, Rajesh Kucheria, Antony Goode, Dominic Yu, Leye Ajayi, London, United Kingdom
Introduction
Endoscopic combined intrarenal surgery (ECIRS) is now a well-established surgical technique in the management of large and complex renal stones. The procedure carries the theoretical advantage of reducing the need for a secondary puncture. The primary objective of this study was to identify whether ECIRS was associated with a lower secondary puncture rate, when compared to standard supine PCNL (S-PCNL). Secondary outcomes measured were stone-free rate, complication rate and number of post-operative blood transfusions.
Methods
Data were prospectively collected on all consecutive patients undergoing either S-PCNL or ECIRS at a tertiary referral stone centre in London, UK from 2007 to 2023. S-PCNL was carried out using 30Fr access and ECIRS was performed in the Galdakao-modified supine Valdivia position. Patient demographics, stone characteristics, and surgical outcomes (including the need for a secondary puncture and stone-free rate) were recorded. Complications of blood transfusion requirement, bowel injury, and urosepsis were also recorded. Propensity score matching was used to adjust for potentially confounding factors, which included age, body mass index, ASA grade and stone complexity (size, density, location and Guy’s stone score).
Results
696 patients were identified who underwent either S-PCNL (n=532) or ECIRS (n=164). After propensity score matching, 157 patients in each group were matched (314 patients in total). ECIRS was associated with a significantly lower secondary puncture rate when compared to PCNL (3.2% vs 7.6%, p=<0.05). Stone free rate was higher in the ECIRS cohort compared to the S-PCNL cohort (90% vs 84%, p=<0.05). Complication rates between ECIRS and S-PCNL were similar (6.4% vs 9.6%, respectively, p=0.15). Blood transfusion rates were not significantly different with two blood transfusions being required in the PCNL group and no blood transfusions being required in the ECIRS group.
Conclusions
This study demonstrates that the use of ECIRS can reduce the need for a secondary puncture when compared to S-PCNL. Higher stone free rate was observed in the ECIRS group whilst a comparable complication rate was maintained. This study suggests that ECIRS brings advantages in potentially reducing intraoperative renal trauma and therefore could reduce blood loss. As ECIRS continues to be used in favour of the traditional S-PCNL for select cases, larger comparative studies are needed to evaluate its potential advantages in surgical outcomes.
Source Of Funding
None to declare.
Author Block
Thomas Fonseka*, Lara Logrado, Filipa Dionisio, Darrell Allen, Anuj Goyal, Gidon Ellis, Rajesh Kucheria, Antony Goode, Dominic Yu, Leye Ajayi, London, United Kingdom
Introduction
Endoscopic combined intrarenal surgery (ECIRS) is now a well-established surgical technique in the management of large and complex renal stones. The procedure carries the theoretical advantage of reducing the need for a secondary puncture. The primary objective of this study was to identify whether ECIRS was associated with a lower secondary puncture rate, when compared to standard supine PCNL (S-PCNL). Secondary outcomes measured were stone-free rate, complication rate and number of post-operative blood transfusions.
Methods
Data were prospectively collected on all consecutive patients undergoing either S-PCNL or ECIRS at a tertiary referral stone centre in London, UK from 2007 to 2023. S-PCNL was carried out using 30Fr access and ECIRS was performed in the Galdakao-modified supine Valdivia position. Patient demographics, stone characteristics, and surgical outcomes (including the need for a secondary puncture and stone-free rate) were recorded. Complications of blood transfusion requirement, bowel injury, and urosepsis were also recorded. Propensity score matching was used to adjust for potentially confounding factors, which included age, body mass index, ASA grade and stone complexity (size, density, location and Guy’s stone score).
Results
696 patients were identified who underwent either S-PCNL (n=532) or ECIRS (n=164). After propensity score matching, 157 patients in each group were matched (314 patients in total). ECIRS was associated with a significantly lower secondary puncture rate when compared to PCNL (3.2% vs 7.6%, p=<0.05). Stone free rate was higher in the ECIRS cohort compared to the S-PCNL cohort (90% vs 84%, p=<0.05). Complication rates between ECIRS and S-PCNL were similar (6.4% vs 9.6%, respectively, p=0.15). Blood transfusion rates were not significantly different with two blood transfusions being required in the PCNL group and no blood transfusions being required in the ECIRS group.
Conclusions
This study demonstrates that the use of ECIRS can reduce the need for a secondary puncture when compared to S-PCNL. Higher stone free rate was observed in the ECIRS group whilst a comparable complication rate was maintained. This study suggests that ECIRS brings advantages in potentially reducing intraoperative renal trauma and therefore could reduce blood loss. As ECIRS continues to be used in favour of the traditional S-PCNL for select cases, larger comparative studies are needed to evaluate its potential advantages in surgical outcomes.
Source Of Funding
None to declare.