EXPERIENCE OF ENDOSCOPIC COMBINED INTRARENAL SURGERY FOR TREATMENT OF STAGHORN NEPHROLITHIASIS

Endoscopic combined intrarenal surgery (ECIRS) was first described in 2008 and involved simultaneous use of antegrade and retrograde approaches to the renal calyx. These endoscopic techniques together improve the efficacy and emphasize clinical benefits of the combined approach in treating patients with staghorn nephrolithiasis.

Objective. To evaluate the efficacy and safety of ECIRS by analyzing a stone-free rate and complication rate.

Material and methods. We assessed prospectively patients with staghorn kidney stones who underwent ECIRS between 2019 and 2024. We compared sex, age, body mass index, preoperative and postoperative hemoglobin levels, number and types of surgical interventions, number of percutaneous approaches, surgery duration, length of hospital stay, and complications between the groups. The size and density of the stones were evaluated by unenhanced and contrast-enhanced multislice computed tomography.

Results. Our study included 84 patients divided into groups according to the staghorn nephrolithiasis classification developed at the Lopatkin Scientific Research Institute of Urology (C1, 8 patients; C2, 14 patients; C3, 32 patients; C4, 30 patients). In 70 patients the stones were successfully removed in one surgery, and the stone-free rate effect was achieved. In C3 and C4 groups 6 and 8 patients, respectively, underwent repeated endoscopic interventions. In 4 cases in C3 group and 6 cases in C4 group additional percutaneous approach was required. The stone-free status and complication rates were 83.3% and 38.1%, respectively. Most complications (28.6%) were minor (fever, pain, gross hematuria). In 3 patients (9.4%) in C3 group and 4 patients (13.3%) in C4 group, antibiotic therapy was adjusted due to the development of acute pyelonephritis. One patient (3.3%) in C4 group was admitted to an intensive care unit due to sepsis. The length of hospital stay was 8.25±1.75 bed-days.

Conclusions. ECIRS will allow adaptation of the operation to a specific patient, to the size and localization of the calculi and the anatomy the urinary system. According to the results of the study, the method has a high level of safety and effectiveness, which will reduce the percentage of complications, the number of bed-days, the frequency of repeated interventions and percutaneous accesses to the kidney, it will also ensure a high rate of calculi absence.

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