Mini-endoscopic combined intrarenal surgery (mini-ECIRS) for complex urolithiasis.

Abstract

To miniaturize endourological procedures, mini-Endoscopic Combined Intrarenal Surgery (mini-ECIRS) has emerged as a promising alternative in the treatment of complex kidney and ureteral stones. To date, some data available in the literature have shown good outcomes regarding effectiveness and safety. This study aimed to evaluate the results and postoperative complications of mini-ECIRS in our series. A prospective analysis of consecutive patients who underwent mini-ECIRS at our center between June 2022 and March 2024 was performed. Demographic characteristics were collected, and the patients were divided according to de Guy's Stone Score (GSS). The stone-free rate (SFR) was classified into the grades according to non-contrast abdominal computed tomography 4 weeks after the procedure: Grade A (no stones), Grade B (< /= 2mm fragments), and Grade C (2.1-4mm fragments). 60 patients were included and enrolled in the study. The median stone volume was 3352 mm3 (2602-4573) and the median stone density was 1054 HU (774-1284). SFR Grade A was achieved in 48 patients (80%) and Grade C in 12 patients (20%). Thirteen patients (21.7%) presented Clavien-Dindo Grade I-II complications. When we divided the patients into two groups according to the GSS classification, GSS 1-3 presented significantly fewer postoperative complications and higher SFR. Mini-ECIRS is a safe and effective procedure for treating of complex renal and ureteral stones. Patients with GSS 4 are more likely to need a second look procedure and present a higher probability of postoperative complications. Larger and randomized studies are required to confirm these favorable outcomes.