Category: Clinical Stones: PCNL
Introduction & Objective :
ECIRS combines a simultaneous antero-retrograde approach aiming to treat stones located in every part of the urinary tract. Miniaturizations of renal access were introduce to reduce the morbidity of the procedure without affecting the stone free rate and widening the indications for percutaneous procedures. Aim of our study was to evaluate our first year of experience of miniaturized ECIRS in the Galdakao-Modified Supine Valdivia (GMSV) position.
Retrospective evaluation on 24 patients who underwent miniaturized ECIRS in GMSV position from January 2017 to February 2018. In this period we used 3 different percutaneous accesses: 4,8 Fr (microECIRS), 11/12 Fr (ultraminiECIRS) and 16 Fr (miniECIRS). Patients were divided into three goups according to access diameter: group 1 subjected to microECIRS, group 2 to ultraminiECIRS and group 3 to miniECIRS. All patients underwent a pre-operative contrast CT scan. Clinical outcomes such as stone-free rate, complications (according to Clavien-Dindo classification) and hospital stay were evaluated and described. Patients were followed with a non contrast CT scan 1 month after the procedure. Stone free was defined for residual fragments < 4 mm and no need for further procedures.
Lithotripsy was performed with Holmium YAG laser (Sphinx Jr 30W) in all cases (200 µ fiber was used for micro and ultraminiECIRS, 550µ fiber for miniECIRS). Group 1: performed for lower pole stones US guide with a 4.8 Fr all-seeing needle. Lithotripsy was performed by through the 16G needle sheath of the integrated system. All fragments were removed retrogradly. Group 2: performed for kidney stone < 20 mm. Punture was performed by ultrasound guidance followed by a “single-step dilation”. 7 Fr nephroscope was used. Group 3: dilation was carried out by progressive Teflon dilator, up to 16 Fr. 12 Fr nephroscope was used. Patients were folowed with CT scan at a mean time of one month after surgery. All intra and postoperative characteristics and outcomes are reported in tab. 1.10 patients underwent a second-look RIRS in case of significant residual fragments at final intraoperative evaluation or at the CT scan. Overall, 5 patients experienced post-operative complications (post-operative fever in all case, Clavien II)
Conclusions : Minizaturized ECIRS, according to our experience, allows to achieve good stone free rate with a very low morbidity. Simultaneous ureteral and renal stones can benefit of this techniques, as well as stones of the lower pole with caliceal anatomy infavourable to a pure retrograde access.
Orazio Maugeri– Cuneo, Piemonte, Italy
Ettore Dalmasso– Consultant , AO Santa Croce e Carle Cuneo, Cuneo, Piemonte, Italy
Diego Bernardi– Cuneo, Piemonte, Italy
Germano Chiapello– Cuneo, Piemonte, Italy
Claudio Dadone– Cuneo, Piemonte, Italy
Elisa Galletto– cuneo, Piemonte, Italy
Mauro Mediago– Cuneo, Piemonte, Italy
Filippo Oppezzi– Cuneo, Piemonte, Italy
Fabio Venzano– Cuneo, Piemonte, Italy
Giuseppe Arena– Cuneo, Piemonte, Italy