Mp18-17 comparison of safety and efficacy between prone split-leg and modified supine valdivia positions in endoscopic combined intrarenal surgery (ecirs): a multi-institutional analysis

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-17 COMPARISON OF SAFETY AND EFFICACY BETWEEN PRONE SPLIT-LEG AND MODIFIED SUPINE VALDIVIA POSITIONS IN ENDOSCOPIC COMBINED INTRARENAL SURGERY (ECIRS): A MULTI-INSTITUTIONAL ANALYSIS Shuzo Hamamoto, Shinsuke Okada, Takaaki Inoue, Kazumi Taguchi, Kengo Kawase, Tomoki Okada, Ryosuke Chaya, Tatsuya Hattori, Atsushi Okada, and Takahiro Yasui Shuzo HamamotoShuzo Hamamoto More articles by this author , Shinsuke OkadaShinsuke Okada More articles by this author , Takaaki InoueTakaaki Inoue More articles by this author , Kazumi TaguchiKazumi Taguchi More articles by this author , Kengo KawaseKengo Kawase More articles by this author , Tomoki OkadaTomoki Okada More articles by this author , Ryosuke ChayaRyosuke Chaya More articles by this author , Tatsuya HattoriTatsuya Hattori More articles by this author , Atsushi OkadaAtsushi Okada More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endoscopic combined intrarenal surgery (ECIRS) is a hybrid therapy combining PCNL and retrograde intrarenal surgery using flexible ureteroscope (RIRS). The Galdalao-modified supine Valdivia (GMSV) position has been commonly used in ECIRS. But recently, we have reported that the prone split-leg (PSL) position might be available for this procedure. However, there is no comparative study analysing the efficacy of the PSL versus the MSV position in ECIRS for renal calculi. In this study, we retrospectively evaluated the safety and efficacy of PSL and MSV positions in ECIRS in a multi institutional study. METHODS: A multi-institutional, retrospective cohort study was conducted between January 2014 and December 2018. The stone-free (SF) rate and complications were compared between two positions. Anatomical variations were evaluated using contrast-enhanced CT imaging. RESULTS: In total, 118 and 100 patients underwent ECIRS in the PSL and GMSV positions. The renal punctures in the PSL position were predominantly executed through the lower calyces (78.0%), whereas those in the GMSV position were primarily performed through the middle calyces (64.0%) (p <0.001). There were no significant differences in the SF rate between two positions (78.8 vs 76.0%; p=0.629). However, with regard to complications, the urinary tract injury (p=0.033), and the incidence of febrile urinary tract infection (fUTI) (23.7 vs 10.0%; p=0.011) in the PSL position were significantly higher than those in the GMSV position. Longer surgical time (odds ratio: 3.410), positive urine culture (odds ratio: 2.040) and PSL position (odds ratio: 3.880) were independent predictors of postoperative fUTI. The tilt of the major renal axis was significantly greater in the prone position than the corresponding values in the oblique position (19.4 vs 8.5°; p=0.019). CONCLUSIONS: Anatomical variation might result in the differences of renal puncture calyx. ECIRS in the GMSV position may bring equal SF status, with a longer surgical time but less complications including fUTI and urinary tract injury than the PSL position. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e324-e325 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shuzo Hamamoto More articles by this author Shinsuke Okada More articles by this author Takaaki Inoue More articles by this author Kazumi Taguchi More articles by this author Kengo Kawase More articles by this author Tomoki Okada More articles by this author Ryosuke Chaya More articles by this author Tatsuya Hattori More articles by this author Atsushi Okada More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement Loading ...