Outcomes Following Institutional Adoption of Vacuum-Assisted Micro-ECIRS for Symptomatic 1–2 cm Lower Pole Renal Stones: A Retrospective Non-Concurrent Cohort Study
- 1Department of Urology, Kayseri City Hospital, 38080 Kayseri, Türkiye
- 2Department of Urology, Kayseri Faculty of Medicine, University of Health Sciences, 38080 Kayseri, Türkiye
Abstract
Background/Objectives: Micro-percutaneous nephrolithotomy (micro-PCNL) offers direct access to lower pole stones but has limited fragment evacuation. Vacuum-assisted micro-endoscopic combined intrarenal surgery (micro-ECIRS) adds flexible ureteroscopy and suction. We evaluated outcomes after institutional adoption of this technique for symptomatic 1–2 cm lower pole stones. Methods: This retrospective non-concurrent cohort included 81 consecutive adults treated between January 2016 and July 2025 (micro-ECIRS, n = 42; micro-PCNL, n = 39). Only micro-PCNL procedures (n = 33) preceded January 2021. One-month low-dose noncontrast computed tomography (earlier, pre-intervention, in four patients) classified outcomes as Grade A (no residual fragment), Grade B (none >2 mm), or Grade C (none >4 mm; main outcome). Comparisons were unadjusted. Results: Grade C was attained in 90.5% (micro-ECIRS) versus 64.1% (micro-PCNL) (absolute difference 26.4 percentage points, 95% confidence interval [CI] 8.2–43.1; risk ratio [RR] 1.41, 95% CI 1.09–1.82; p = 0.007) and Grade B in 71.4% versus 46.2% (p = 0.025). Grade A did not differ significantly (42.9% vs. 28.2%; p = 0.246). Secondary puncture (4.8% vs. 28.2%) and auxiliary procedures (4.8% vs. 25.6%) were less frequent after micro-ECIRS (both p < 0.05). Complications did not differ significantly (11.9% vs. 30.8%; p = 0.055). Conclusions: In this retrospective, predominantly non-concurrent cohort, institutional adoption of vacuum-assisted micro-ECIRS was associated with higher rates of no residual fragment larger than 2 mm or 4 mm and fewer additional punctures and subsequent procedures. A difference in complete stone clearance was not demonstrated. Treatment–era confounding, baseline imbalance, and complete-case selection prevent causal attribution to the technique.
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BibTeX
@article{bicer2026outcomes,
title = {{Outcomes Following Institutional Adoption of Vacuum-Assisted Micro-ECIRS for Symptomatic 1–2 cm Lower Pole Renal Stones: A Retrospective Non-Concurrent Cohort Study}},
author = {Hüseyin Biçer and Abdullah Gölbaşı and Burak Elmaağaç and Ali Yasin Özercan and Hasan Oruç Eroğlu and Mert Ali Karadağ},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218534},
url = {https://www.mdpi.com/2077-0383/15/21/8534},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Outcomes Following Institutional Adoption of Vacuum-Assisted Micro-ECIRS for Symptomatic 1–2 cm Lower Pole Renal Stones: A Retrospective Non-Concurrent Cohort Study
AU - Hüseyin Biçer
AU - Abdullah Gölbaşı
AU - Burak Elmaağaç
AU - Ali Yasin Özercan
AU - Hasan Oruç Eroğlu
AU - Mert Ali Karadağ
PY - 2026
DA - 2026/11/02
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218534
UR - https://www.mdpi.com/2077-0383/15/21/8534
AB - Background/Objectives: Micro-percutaneous nephrolithotomy (micro-PCNL) offers direct access to lower pole stones but has limited fragment evacuation. Vacuum-assisted micro-endoscopic combined intrarenal surgery (micro-ECIRS) adds flexible ureteroscopy and suction. We evaluated outcomes after institutional adoption of this technique for symptomatic 1–2 cm lower pole stones. Methods: This retrospective non-concurrent cohort included 81 consecutive adults treated between January 2016 and July 2025 (micro-ECIRS, n = 42; micro-PCNL, n = 39). Only micro-PCNL procedures (n = 33) preceded January 2021. One-month low-dose noncontrast computed tomography (earlier, pre-intervention, in four patients) classified outcomes as Grade A (no residual fragment), Grade B (none >2 mm), or Grade C (none >4 mm; main outcome). Comparisons were unadjusted. Results: Grade C was attained in 90.5% (micro-ECIRS) versus 64.1% (micro-PCNL) (absolute difference 26.4 percentage points, 95% confidence interval [CI] 8.2–43.1; risk ratio [RR] 1.41, 95% CI 1.09–1.82; p = 0.007) and Grade B in 71.4% versus 46.2% (p = 0.025). Grade A did not differ significantly (42.9% vs. 28.2%; p = 0.246). Secondary puncture (4.8% vs. 28.2%) and auxiliary procedures (4.8% vs. 25.6%) were less frequent after micro-ECIRS (both p < 0.05). Complications did not differ significantly (11.9% vs. 30.8%; p = 0.055). Conclusions: In this retrospective, predominantly non-concurrent cohort, institutional adoption of vacuum-assisted micro-ECIRS was associated with higher rates of no residual fragment larger than 2 mm or 4 mm and fewer additional punctures and subsequent procedures. A difference in complete stone clearance was not demonstrated. Treatment–era confounding, baseline imbalance, and complete-case selection prevent causal attribution to the technique.
SN - 2077-0383
ER -