Divisão de Urologia, Departamento de Cirurgia, Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil.
University of Western Ontario in London, Canada.
Int Braz J Urol. 2024 Nov-Dec;50(6):714-726. doi: 10.1590/S1677-5538.IBJU.2024.9921.
Endoscopic Combined Intrarenal Surgery (ECIRS) has emerged as a promising technique for the management of large and complex kidney stones, potentially offering advantages over traditional Percutaneous Nephrolithotomy (PCNL). This study aims to evaluate best practices, outcomes, and future perspectives associated with ECIRS.
A comprehensive PubMed search was conducted from 2008 to 2024, using MESH terms and the following key words: "ECIRS" and "Endoscopic Combined Intrarenal Surgery" The search yielded 157 articles, including retrospective cohort studies, two randomized controlled trials (RCTs), and four meta-analyses comparing ECIRS with PCNL. Most important findings were summarized regarding indications, patient positioning, kidney access, tract size, surgical outcomes, and complications.
ECIRS demonstrated higher stone-free rate, lower complication rate, and a reduced need for multiple procedures compared to traditional PCNL. Additionally, ECIRS has the potential to integrate new technologies to further enhance outcomes.
ECIRS demonstrates significant advantages in the management of large kidney stones. Future research should focus on well-designed RCTs to provide robust evidence of its efficacy, safety, and cost-effectiveness, potentially establishing ECIRS as the first option treatment for complex kidney stones.
经内腔镜联合肾脏内手术（ECIRS）作为一种治疗大而复杂肾结石的有前途的技术已经出现，它可能优于传统的经皮肾镜碎石术（PCNL）。本研究旨在评估与 ECIRS 相关的最佳实践、结果和未来展望。
对 2008 年至 2024 年的 PubMed 进行了全面检索，使用 MESH 术语和以下关键词：“ECIRS”和“经内腔镜联合肾脏内手术”。搜索结果共获得 157 篇文章，包括回顾性队列研究、两项随机对照试验（RCT）和四项比较 ECIRS 与 PCNL 的荟萃分析。总结了关于适应证、患者体位、肾脏入路、通道大小、手术结果和并发症的最重要发现。
与传统的 PCNL 相比，ECIRS 显示出更高的结石清除率、更低的并发症发生率和减少多次手术的需求。此外，ECIRS 有可能整合新技术，进一步提高疗效。
ECIRS 在大肾结石的治疗中显示出显著的优势。未来的研究应集中在精心设计的 RCT 上，以提供其疗效、安全性和成本效益的可靠证据，有可能将 ECIRS 确立为治疗复杂肾结石的首选方法。
