الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Nephrolithiasis is a common condition that affects people all around the world. Endoscopic therapy of kidney stones has replaced old traditional open surgery in the era of minimally invasive surgery.
Complex renal stones represent a great challenge for urologists; because we need to remove such large stones with the least invasive techniques, no morbid complications and with very smooth recovery.
The gold standard for the treatment of complex and big kidney stones is PCNL. PCNL offers a revolution in renal stone therapy, incorporating all new procedures and instruments into a very small incision of less than 1 cm. Recently with advanced technology, Retrograde intrarenal surgery (RIRS) has emerged and became a commonly used and an important treatment modality to get rid of stones less than two cm. Supine position has been recently introduced as a safe and effective position to replace traditional prone position to access the kidney percutaneously to avoid a lot of anaesthesia complications. This paved the way for simultaneous combined access to the kidney in a more ergonomic position called GMSV position in a procedure called ECIRS.
The whole idea of this technique is that we can access a kidney stone whatever its size and orientation in the pelvicalyceal system retrogradely through urethra and antegradely through percutaneous access simultaneously to clear all the stone in the same session with a single percutaneous tract in short time.
This will facilitate integrated action between two surgeons endoscopically to remove whole of the stone.
So the aim of this study is to assess the safety and efficacy of ECIRS in the management of complex renal stones.
This study was prospectively conducted and included 22 cases, who underwent ECIRS using the GMSV position for management of complex renal stones in the Department of Genitourinary Surgery, Alexandria Main University Hospital.
Demographic data, stone and kidney characters, operative time, stone-free rate, intraoperative and postoperative complications were recorded.
The mean stone size was 5.54(±1.31) CM. The stone-free rate SFR was (86.4 %) which is very good and (95.4 %) after reintervention. The mean operative time was 72.64 (±23.92) minutes which is relatively very good for such stone burden. The average fluoroscopy time was 2.74 Minutes. The complication rate was 9.1 % of cases and all of these complications were of grade 2 with mild postoperative pain and minimal analgesia requirements.
So ECIRS can be introduced as a highly effective, safe, and time-saving technique for the management of complex renal stones.