Non-papillary, prone approach for endoscopic combined intrarenal surgery: our experience

BACKGROUND: This study was conducted in order to assess the safety and efficacy of non-papillary prone endoscopic combined intrarenal surgery (ECIRS) for patients with urolithiasis.METHODS: The surgeries were performed at a high-volume tertiary center. This retrospective study includes 83 patients who underwent ECIRS between February 2019 and March 2025. The inclusion criteria for ECIRS included complex stones, multiple stones in different calyces, and staghorn calculi. The procedures were conducted by two highly-experienced surgeons. The average patient age was 53.96 years, with a mean stone diameter of 40.33 mm. Nonpapillary puncture was performed and either a 22Fr (mini-percutaneous nephrolithotomy [PCNL]) or 30Fr (standard PCNL) access was implemented.RESULTS: The average operative time was 50.92 minutes, with a final stone-free rate (SFR) of 89.2%. Postoperative complications were observed in 14.5% of the patients, all classified as Grade II, with temporary fever and bleeding being the most common. Comparisons between mini-PCNL (22Fr) and standard PCNL (30Fr) revealed no statistically significant differences in operative time, hemoglobin drop, SFR, or complication rates.CONCLUSIONS: Non-papillary prone ECIRS continues to be a feasible,safe and efficient approach for patients with complex stone disease and anatomical abnormalities.