Urology

ECIRS in Supine PCNL: A Comprehensive Approach to Stone Removal

Dr. Mohan Keshavamurthy Jun 26, 2024

In the realm of urological procedures for kidney stone management, encountering scenarios where traditional approaches fall short is not uncommon. Suppose you encounter a situation during a supine percutaneous nephrolithotomy (PCNL) where a fragment remains lodged in a calyx, inaccessible to standard techniques. What options do you have?

Enter Endoscopic Combined Intra Renal Surgery (EC IRS), an evolved technique offering a comprehensive solution to such challenges. Let's delve deeper into what this innovative approach entails and how it revolutionizes stone clearance.

EC IRS involves the simultaneous execution of both PCNL and Retrograde Access to Renal Stones (RARS) during a single procedure. The unique advantage of the supine position in PCNL enables seamless integration of anti-grade and retrograde approaches, significantly enhancing stone retrieval capabilities.

In practical terms, if a stone proves elusive via anti-grade access, a flexible retroscope is passed retrograde through the urethra to locate and clear the stone. This combined approach ensures thorough clearance, even addressing small, inaccessible stones often encountered in conventional PCNL.

The versatility of EC IRS extends further, allowing tailored management for each patient's specific needs. Whether the stone is lodged deep within a calyx or situated in a challenging anatomical location, the EC IRS technique, coupled with the supine position, offers unparalleled flexibility and efficiency.

Moreover, the adoption of supine PCNL and EC IRS translates to numerous patient benefits. Anesthesia management becomes more straightforward, patient monitoring is enhanced, and recovery times are significantly reduced. Additionally, procedural duration is minimized, optimizing overall efficiency and patient comfort.

With access to a diverse array of endoscopic instruments, including standard, mini, and ultra-mini nephroscopes, practitioners have the flexibility to adapt to varying clinical scenarios seamlessly. This versatility extends to the ability to puncture multiple calyces and integrate Retrograde Intra Renal Surgery (RIRS) as needed, ensuring comprehensive stone management.

In conclusion, the integration of supine PCNL with EC IRS represents a paradigm shift in kidney stone treatment, offering unparalleled precision, efficiency, and patient-centric care. By harnessing the full potential of innovative techniques, urologists can achieve optimal stone clearance outcomes, providing patients with lasting relief and improved quality of life.