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Ambulatory Minimally-invasive Endoscopic Combined Intra-Renal Surgery in management of Large Impacted Proximal Ureteral Calculi: A feasibility study at a tertiary referral centre

J Endourol. 2022 Nov 18. doi: 10.1089/end.2022.0234. Online ahead of print.


AIM: To conduct a comparative, non-randomised study to assess the feasibility of mini-Endoscopic combined Intra Renal Surgery(ECIRS) using supine Mini-Percutaneous nephrolithotomy (PCNL) access (16 Fr) in Galdakao Modified Supine Valdivia(GMSV) position for managing proximal large volume impacted ureteral calculi as ambulatory day-care surgery vis-a-vis standalone ureteroscopy with push-back PCNL, if needed. The primary aim was to study the outcomes and stone-free rates. Secondary aim was to compare the intra-operative and short-term post-operative complications.

MATERIALS AND METHODS: Data of sixty patients undergoing ECIRS(Group 1) from January 2016 to December 2019 were collected prospectively in a non-randomized fashion from a single centre after ethics committee approval. A matched-paired analysis was performed with retrospectively collated data of 60 patients undergoing standard ureteroscopy / pushback PCNL(Group 2) using analysis of variance, Fisher’s exact test, and Chi-square test. P < 0.05 was considered statistically significant.

OUTCOMES AND RESULTS: GROUP 1 patients had a significantly shorter procedure time vs GROUP 2 (42.1 ± 11.2 minutes vs 52.1 ± 13.7 minutes, p <0.001). GROUP 1 (59/60) patients had an overall single-stage (SFR) of 98.3% which was significantly higher than single-stage SFR of 83% in GROUP 2 (50/60) (p<0.002). GROUP 2 patients had a higher incidence of fever (10 vs 4, p=0.01). However, there were no cases of sepsis in either group. Rest of the complications were comparable for both the need for ancillary procedures was significantly higher in GROUP 2 (10% vs 1.7%, p<0.001). Patients were discharged on same day in both groups.

CONCLUSIONS: The findings of our study suggest that, in large and impacted proximal ureteric stones, combined minimally-invasive endoscopic approach offers the best option to render the patient stone-free by a single intervention. With better intra- and post-operative outcomes and safety profile, Mini-ECIRS may be considered as an ambulatory procedure in this setting.

PMID:36401507 | DOI:10.1089/end.2022.0234

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