Abstract
Modern-day percutaneous nephrolithotomy (PNL) has undergone considerable evolution, mainly driven by the improvement in access techniques, endoscopic instrumentation technology, lithotripsy devices and drainage management. The introduction of the supine and supine-modified positions is also part of this evolution, enabling comfortable and safe procedures from an anaesthesiological point of view, and an easy combined retrograde surgery [Endoscopic Combined IntraRenal Surgery (ECIRS)], allowing tailoring of the procedure on the patient, the dynamic anatomy of the collecting system and the urolithiasis. The conceptual value of ECIRS extends beyond the single diagnostic and active advantages due to the simultaneous contribution of the flexible retrograde ureteroscopy: the merit consists in the promotion of the versatile attitude of the urologist, and in the fulfillment of a personalized stone management. ECIRS has no pretensions of superiority, but for sure is a new safe and effective way of interpreting PNL, in the hands of an experienced surgical team.
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References
Rupel E, Brown R (1941) Nephroscopy with removal of stone following nephrostomy for obstructive calculus anuria. J Urol 46:177–182
Harris RD, McLaughlin AP 3rd, Harrell JH (1975) Percutaneous nephroscopy using fiberoptic bronchoscope: removal of renal calculus. Urology 6:367–369
Ferstrom I, Johansson B (1976) Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 10:257–259
Marshall V (1964) Fiberoptics in urology. J Urol 91:110–114
Lyon ES, Banno JJ, Schoenberg HW (1979) Transurethral ureteroscopy in men using juvenile cystoscopy equipment. J Urol 122:152–153
Keating MA, Heney NM, Young HH 2nd et al (1986) Ureteroscopy: the initial experience. J Urol 135:689–693
Streem SB, Lammert G (1992) Long-term efficacy of combination therapy for struvite staghorn calculi. J Urol 147:563–566
Traxer O, Letendre J (2014) Extracorporeal lithotripsy endoscopically controlled by ureterorenoscopy (LECURS): a new concept for the treatment of kidney stones-first clinical experience using digital ureterorenoscopes. World J Urol 32:715–721
Zeng G, Zhao Z, Wu W, Zhong W (2014) Combination of debulking single-tract percutaneous nephrolithotomy followed by retrograde intrarenal surgery for staghorn stones in solitary kidneys. Scand J Urol 48:295–300
Lawson RK, Murphy JB, Taylor AJ, Jacobs SC (1983) Retrograde method for percutaneous access to kidney. Urology 22:580–582
Hunter PT, Hawkins IF, Finlayson B et al (1983) Hawkins-Hunter retrograde transcutaneous nephrostomy: a new technique. Urology 22:583–587
Kawahara T, Ito H, Terao H et al (2012) Ureteroscopy assisted retrograde nephrostomy: a new technique for percutaneous nephrolithotomy (PCNL). BJU Int 110:588–590
Wynberg JB, Paik LJ, Odom BD et al (2014) Body mass index predicts outcome of ureteroscopy-assisted retrograde nephrostomy for percutaneous nephrolithotomy. J Endourol 28:1071–1077
Lehman T, Bagley DH (1988) Reverse lithotomy: modified prone position for simultaneous nephroscopic and ureteroscopic procedures in women. Urology 32:529–531
Grasso M, Lang G, Taylor FC (1995) Flexible ureteroscopically assisted percutaneous renal access. Tech Urol 1:39–43
Grasso M, Lang G, Loisides P et al (1995) Endoscopic management of the symptomatic caliceal diverticular calculus. J Urol 153:1878–1881
Scarpa RM, Cossu FM, De Lisa A et al (1997) Severe recurrent ureteral stricture: the combined use of an anterograde and retrograde approach in the prone splitleg position without X-rays. Eur Urol 31:254–256
Ibarluzea JG, Gamarra MG, Leibar A, Pereira JG (2014) The evolution from prone to supine PNL and from supine PNL to ECIRS: the basque history of endourology. In: Scoffone CM, Hoznek A, Cracco CM (eds) Supine percutaneous nephrolithotomy and ECIRS, 1st edn. Springer, France, pp 15–23
Ibarluzea Gonzàlez G, Gamarra Quintanilla M, Gallego Sànchez JA et al (2001) Percutaneous kidney lithotripsy. Clinical course, indications and current methodology in our lithotripsy unit. Arch Esp Urol 54:951–969
Ibarluzea G, Scoffone CM, Cracco CM et al (2007) Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 100:233–236
Landman J, Venkatesh R, Lee DI et al (2003) Combined percutaneous and retrograde approach to staghorn calculi with application of the ureteral access sheath to facilitate percutaneous nephrostolithotomy. J Urol 169:64–67
Marguet CG, Springhart WP, Tan YH et al (2005) Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi. BJU Int 96:1097–1100
Borin JF (2008) Prone retrograde laser lithotripsy facilitates endoscope-guided percutaneous renal access for staghorn calculi: Two scopes are better than one. J Endourol 22:1881–1883
Sountoulides PG, Kaufmann OG, Louie MK et al (2009) Endoscopy-guided percutaneous nephrostolithotomy: benefits of ureteroscopic access and therapy. J Endourol 23:1649–1654
Scoffone CM, Cracco CM, Cossu M et al (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol 54:1393–1403
Cracco CM, Scoffone CM, Poggio M, Scarpa RM (2010) The patient position for PNL: does it matter? Arch Ital Urol Androl 82:30–31
Scoffone CM, Cracco CM, Poggio M, Scarpa RM (2010) Endoscopic combined intrarenal surgery for high burden renal stones. Arch Ital Urol Androl 82:41–42
Cracco CM, Scoffone CM, Scarpa RM (2011) New developments in percutaneous techniques for simple and complex branched renal stones. Curr Opin Urol 21:154–160
Cracco CM, Scoffone CM (2011) ECIRS (endoscopic combined intrarenal surgery) in the Galdakao-modified supine Valdivia position: a new life for percutaneous surgery? World J Urol 29:821–827
Serra S, Corona A, De Lisa A (2012) Endoscopic combined intra renal surgery (ECIRS) in prone position. Urologia 79 Suppl 19:121–124
Hoznek A, Rode J, Ouzaid I et al (2012) Modified supine percutaneous nephrolithotomy for large kidney and ureteral stones: technique and results. Eur Urol 61:164–170
Nuño de la Rosa I, Palmero JL, Miralles J et al (2014) A comparative study of percutaneous nephrolithotomy in supine position and endoscopic combined intrarenal surgery with flexible instrument. Actas Urol Esp 38:14–20
Scoffone CM, Hoznek A, Cracco CM (2014) Supine percutaneous nephrolithotomy and ECIRS, 1st edn. Springer, France
Hamamoto S, Yasui T, Okada A et al (2014) Endoscopic combined intrarenal surgery for large calculi: simultaneous use of flexible ureteroscopy and mini-percutaneous nephrolithotomy overcomes the disadvantageous of percutaneous nephrolithotomy monotherapy. J Endourol 28:28–33
Patel RM, Okhunov Z, Clayman RV, Landman J (2017) Prone versus supine percutaneous nephrolithotomy: what is your position? Curr Opin Urol 18:26. https://doi.org/10.1007/s11934-017-0676-9
Adeyoju AAB, Sutcliffe N (2014) Anaesthesia for supine and modified supine PNL. In: Scoffone CM, Hoznek A, Cracco CM (eds) Supine percutaneous nephrolithotomy and ECIRS, 1st edn. Springer, France, pp 79–88
Papatsoris A, Masood J, El-Husseiny T et al (2009) Improving patient positioning to reduce complications in prone percutaneous nephrolithotomy. J Endourol 23:831–832
Karami H, Rezaei AR, Mazloomfard MM et al (2012) Effect of surgical position on patient’s arterial blood gases during percutaneous nephrolithotomy. Urol J 9:553–556
Khoshrang H, Falahatkar S, Ilat S et al (2012) Comparative study of hemodynamics electrolyte and metabolic changes during prone and complete supine percutaneous nephrolithotomy. Nephrourol Mon 4:622–628
Basiri A, Soltani MH, Kamranmanesh M et al (2013) Neurologic complications in percutaneous nephrolithotomy. Korean J Urol 54:172–176
Siev M, Motamedinia P, Leavitt D et al (2015) Does peak inspiratory pressure increase in the prone position? An analysis related to body mass index. J Urol 194:1302–1306
Ozayar E, Gulec H, Bayraktaroglu M et al (2016) Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy: from the view of an anaesthesiologist. J Endourol 30:184–188
Daels FPJ, Gonzalez MS (2014) Intraoperative complications: how to avoid them? In: Scoffone CM, Hoznek A, Cracco CM (eds) Supine percutaneous nephrolithotomy and ECIRS, 1st edn. Springer, France, pp 265–277
Miano R, Scoffone C, De Nunzio C et al (2010) Position: prone or supine is the issue of percutaneous nephrolithotomy. J Endourol 24:931–938
Cracco CM, Alken P, Scoffone CM (2016) Positioning for percutaneous nephrolithotomy. Curr Opin Urol 26:81–87
Liu L, Zheng S, Xu Y, Wei Q (2010) Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position. J Endourol 24:1941–1946
Wu P, Wang l, Wang K (2011) Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a metaanalysis. Int Urol Nephrol 43:67–77
Yuan DB, Liu YD, Rao HF et al (2016) Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. J Endourol 30:754–764
Mak DKC, Smith Y, Buchholz N, El-Husseini T (2016) What is better in percutaneous nephrolithotomy—prone or supine? A systematic review. Arab J Urol 14:101–107
Ghani KR, Andonian S, Bultitude M et al (2016) Percutaneous nephrolithotomy: update, trands, and future directions. Eur Urol 70:382–390
Cracco CM, Knoll T, Liatsikos EN et al (2017) Rigid-only versus combined rigid and flexible percutaneous nephrolithotomy: a systematic review. Minerva Urol Nefrol 69:330–341
Sofer M, Barghouthy Y, Bar-Yosef Y et al (2017) Upper calyx accessibility through a lower calyx access is not influenced by morphometric and clinical factors in supine percutaneous nephrolithotomy. J Endourol 31:452–456
Scoffone CM, Cracco CM (2016) Editorial Comment to Risk factors of systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position. Int J Urol 23:692–693
Low RK (1999) Nephroscopy sheath characteristics and intrarenal pelvic pressure: human kidney model. J Endourol 13:205–208
Clayman RV (2000) Nephroscopy sheath characteristics and intrarenal pressure: human kidney model. J Urol 163:1616
Falahatkar S, Allahkhah A, Soltanipour S (2011) Supine percutaneous nephrolithotomy: pro. Urol J 8:257–264
Lezrek M, Bazine K, Ammani A et al (2011) Needle renal displacement technique for the percutaneous approach to the superior calix. J Endourol 25:1723–1726
Yazici CM, Kayhan A, Dogan C (2014) Supine or prone percutaneous nephrolithotomy: do anatomical changes make it worse? J Endourol 28:10–16
Sofer M, Giusti G, Proietti S et al (2016) Upper calyx approachability through a lower calyx access for prone versus supine percutaneous nephrolithotomy. J Urol 195:377–382
Hoznek A, Daels FPJ, Kimuli MNT et al (2014) ECIRS: patient positioning and organization of the operating room. In: Scoffone CM, Hoznek A, Cracco CM (eds) Supine percutaneous nephrolithotomy and ECIRS, 1st edn. Springer, France, pp 109–125
Lojanapiwat B (2013) The ideal puncture approach for PCNL: fluoroscopy, ultrasound or endoscopy? Indian J Urol 29:208–213
Scoffone CM, Ingrosso M, Cracco CM (2017) ECIRS (endoscopic combined intrarenal surgery) in the Galdakao-modified supine Valdivia position. J Urol 197(4):e1284
De la Rosette J, Assimos D, Desai M et al (2011) The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol 25:11–17
Seitz C, Desai M, Haecker A et al (2012) Incidence, prevention, and management of complications following percutaneous nephrolithotomy. Eur Urol 61:146–158
Türk C, Petřík A, Sarica K et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69:475–482
Friedlander JI, Duty BD, Smith AD, Okeke Z (2012) Percutaneous nephrostolithotomy: an assessment of costs for prone and Galdakao-modified supine Valdivia positioning. Urology 80:771–775
Knoll T, Daels F, Desai J et al (2017) Percutaneous nephrolithotomy: technique. World J Urol. https://doi.org/10.1007/s00345-017-2001-0
Curry D, Srinivasan R, Kucheria R et al (2017) Supine PCNL in the Galdakao modified Valdivia position—a high volume single centre experience. J Endourol. https://doi.org/10.1089/end.2017.0064
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Dr. Cesare Marco Scoffone is consultant for Boston Scientific, Coloplast Porgés, Cook Medical, DBI, Olympus, Promed, Storz Medical (same for Lumenis, tutor for courses for Menarini and Recordati in the past). Dr. Cecilia Maria Cracco is tutor for courses of Boston Scientific (same for Menarini and Recordati in the past).
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Scoffone, C.M., Cracco, C.M. Invited review: the tale of ECIRS (Endoscopic Combined IntraRenal Surgery) in the Galdakao-modified supine Valdivia position. Urolithiasis 46, 115–123 (2018). https://doi.org/10.1007/s00240-017-1015-9
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DOI: https://doi.org/10.1007/s00240-017-1015-9