Ann Acad Med Singap. 2026 Sep 7;55(9):404-414. doi: 10.47102/annals-acadmedsg.2025312.
ABSTRACT
INTRODUCTION: This study aimed to compare the clinical outcomes of endoscopic combined intrarenal surgery (ECIRS) in the prone hip-flexed split-leg position with conventional percutaneous nephrolithotomy (PCNL) for the treatment of complex renal calculi.
METHOD: We retrospectively analysed 168 patients with complex renal calculi, including 82 who underwent ECIRS and 86 who underwent conventional PCNL. Baseline demographic and stone characteristics, perioperative outcomes, initial stone-free rate (SFR) within 1-3 days after surgery, final SFR after completion of all planned treatments, auxiliary procedures, double-J stent indwelling duration, length of hospital stay, and postoperative complications were compared between groups. Logistic regression analyses were performed to evaluate factors associated with residual stones after the initial procedure, with additional clinically informed sensitivity analysis using prespecified covariates.
RESULTS: Baseline demographic characteristics, stone features, and postoperative outcomes, including intraoperative ureteral catheterization time, complication rates, Clavien-Dindo classification, and final SFR after completion of all planned treatments, were comparable between the two groups (all P>0.05). In this retrospective cohort, ECIRS in the prone hip-flexed split-leg position was associated with earlier stone clearance after the index procedure, reflected by a higher initial SFR (74.39% versus [vs] 50.00%, P=0.001) and a lower requirement for auxiliary procedures (29.27% vs 46.51%, P=0.021). These findings were accompanied by a shorter hospital stay (6.44 vs 8.61 days, P<0.001), shorter double-J stent indwelling duration (2.81 vs 4.79 weeks, P=0.002), and shorter operative time (P=0.012). Multivariable and sensitivity analyses further demonstrated that ECIRS was independently associated with lower odds of residual stones after the initial procedure (odds ratio 0.40, 95% confidence interval 0.20-0.80, P=0.009).
CONCLUSION: Single-position ECIRS in the prone hipflexed split-leg configuration was feasible for selected patients with complex renal calculi and was associated with earlier stone clearance and shorter perioperative recovery metrics. However, the final SFR after completion of all planned treatments was comparable between groups, and whether this positional configuration confers benefit beyond ECIRS in alternative positions could not be determined from this comparison. Further prospective studies are required to validate these findings.
PMID:42831477 | DOI:10.47102/annals-acadmedsg.2025312