Perrella Rodrigo, Vicentini Fabio Carvalho, Neto Matheus Marques P, Ferreira Daniel Beltrame, Torricelli Fabio C M, Marchini Giovani S, Danilovic Alexandre, Batagello Carlos A, Pellanda Anderson B, Vieira Henrique Cunha, Yadoya Rafael T, Mota Priscila Kuriki Vieira, Cassão Valter Dell Acqua, de Almeida Claro Joaquim Francisco, Nahas William C, Mazzucchi Eduardo
Division of Urology, Military Hospital of Sao Paulo, Sao Paulo, Brazil.
Division of Urology, Hospital das Clínicas, Sao Paulo, Brazil.
World J Urol. 2025 May 6;43(1):275. doi: 10.1007/s00345-025-05455-1.
To compare the efficacy and safety outcomes of Endoscopic Combined Intrarenal Surgery (ECIRS) and Percutaneous Nephrolithotomy (PCNL) in the treatment of kidney stones.
A retrospective matched case-control study was conducted from July 2022 to January 2024, utilizing prospectively collected kidney stone databases from two centers. Patients who underwent PCNL or ECIRS for kidney stone treatment were included. Cases and controls were matched based on stone complexity, using the Guy's Stone Score (GSS) in a 1:2 ratio. Computed tomography (CT) was performed 90 days postoperatively to assess the stone free rate, defined as the absence of residual fragments. The analyzed variables included age, sex, body mass index (BMI), ASA score, comorbidities, stone diameter, GSS, operative time, number of accesses, blood transfusions, hemoglobin drop, hospital stay, stone free rate, and complication rates. Statistical analysis was performed using the Student's t-test for continuous variables and the Chi-square or Fisher's exact test for categorical variables, with significance set at p < 0.05.
A total of 165 patients were included (55 in the ECIRS group and 110 in the PCNL group). Demographic characteristics were comparable between groups. ECIRS demonstrated a higher stone-free rate (81.8% vs. 56.4%; p = 0.001), particularly in complex cases (GSS 3 and 4) (79.2% vs. 41.7%; p = 0.003). There was no significant difference in complication rates between the two groups (21.8% vs. 26.4%; p = 0.607).
ECIRS is an effective treatment, particularly for large and complex kidney stones, offering higher success rates compared to PCNL, with similar complication rates.
比较内镜联合肾内手术（ECIRS）与经皮肾镜取石术（PCNL）治疗肾结石的疗效和安全性结果。
2022年7月至2024年1月进行了一项回顾性配对病例对照研究，利用两个中心前瞻性收集的肾结石数据库。纳入接受PCNL或ECIRS治疗肾结石的患者。病例和对照根据结石复杂性进行配对，采用盖伊结石评分（GSS），比例为1:2。术后90天进行计算机断层扫描（CT）以评估无石率，定义为无残留碎片。分析的变量包括年龄、性别、体重指数（BMI）、美国麻醉医师协会（ASA）评分、合并症、结石直径、GSS、手术时间、穿刺次数、输血、血红蛋白下降、住院时间、无石率和并发症发生率。连续变量采用学生t检验，分类变量采用卡方检验或费舍尔精确检验进行统计分析，显著性设定为p < 0.05。
共纳入165例患者（ECIRS组55例，PCNL组110例）。两组间人口统计学特征具有可比性。ECIRS显示出更高的无石率（81.8%对56.4%；p = 0.001），尤其是在复杂病例（GSS 3和4）中（79.2%对41.7%；p = 0.003）。两组间并发症发生率无显著差异（21.8%对26.4%；p = 0.607）。
ECIRS是一种有效的治疗方法，特别是对于大的和复杂的肾结石，与PCNL相比成功率更高，并发症发生率相似。
