ECIRS (Endoscopic Combined Intrarenal Surgery) is the latest endourologic treatment for large and/or complex urolithiasis, performed with both rigid and flexible endoscopes to treat large stone burdens. Kidney stones up to the size of 5 cm can be treated by this method. This is a safe, efficient, and reliable method to remove renal stones.

ECIRS is a combined endoscopic surgery where one surgeon performs the procedure through a natural orifice. The doctor uses an endoscope—a thin, flexible tube with a camera at the end—to reach the bladder through the urethra. The endoscope then moves to the area of urine storage in the kidney, where it identifies and blasts the stones with a laser.

Meanwhile, another surgeon proceeds with supine PCNL (Percutaneous Nephrolithotomy), a minimally invasive procedure involving a small incision in the side and inserting a thin tube called a nephroscope into the kidney. The nephroscope, equipped with a camera and light, allows the surgeon to see and break up the stone using specialized instruments. The broken pieces are then removed through the tube.

Procedure

1. Initial Examination:

• At your consultation visit, we will check your kidney function and perform a screening ultrasound to assess the number and size of the stones.
• During the comprehensive urology examination, we will measure the density of your stones to determine the best laser setting for removal.
• We will also create a roadmap of your kidneys (KUB) and evaluate the overall kidney health.

2. Duration:

The duration of ECIRS surgery depends on the size of the stone:

• Large stones take more time, while average-sized stones take less.

Advantages of ECIRS:

1. Effective Stone Removal: Highly effective for large and complex kidney stones that are difficult to remove using other methods.
2. Minimally Invasive: Uses a small skin incision combined with an endoscopic procedure, minimizing trauma to surrounding tissues and organs.
3. Faster Recovery: Quicker recovery than open surgery, with less pain and sooner return to normal activities.
4. Reduced Hospital Stay: Typically shorter hospital stay compared to open surgery—often discharged within a day or a few days.
5. Lower Complication Rates: Although no procedure is without risks, ECIRS has relatively low complication rates when performed by skilled surgeons.
6. Preservation of Kidney Function: Aims to maintain kidney function by removing stones that might obstruct urine flow and cause damage.
7. High Success Rates: Successfully clears stones of various sizes and compositions, even those resistant to other treatments.
8. Versatility: Suitable for various types of kidney stones, including staghorn and complex stones.
9. Improved Quality of Life: Eliminates symptoms such as pain, discomfort, and UTIs, enhancing the patient’s quality of life.
10. Advanced Imaging Guidance: Uses fluoroscopy or ultrasound for precise targeting of stones, minimizing the risk of damage to surrounding structures.

Before the Procedure:

1. Medical Evaluation:

• A complete medical evaluation, including a review of your medical history and imaging studies.

2. Preoperative Instructions:

• You may be given specific instructions about fasting before the procedure.
• Inform your healthcare team about any medications you are taking, as some may need to be adjusted or temporarily stopped.

3. Imaging Studies:

• Imaging studies like CT scans may be done to locate the kidney stone and plan the procedure.

During the Procedure:

1. Anaesthesia:

• ECIRS is typically performed under general anaesthesia, so you will be unconscious during the procedure.

2. Access Point Creation:

• A small incision or puncture is made on the lateral back to access the kidney.

3. Guidewire Placement:

• A flexible wire is inserted through the incision to guide the instruments.

4. Dilation:

• The access tract is gradually dilated to allow the nephroscope to visualize and remove kidney stones.

5. Stone Removal:

• The nephroscope is used to locate and break up the stones. Larger stones are fragmented before removal.

6. Placement of Drain:

• A drain may be placed to help remove residual fragments and fluids.

7. Combining with RIRS:

• Simultaneously, another surgeon uses an endoscope through the urethra to access the bladder and kidney, identifying and blasting the stones with a laser.

After the Procedure:

1. Recovery Room:

• You will be monitored in the recovery room as you wake up from anaesthesia.

2. Hospital Stay:

• The hospital stay duration depends on the size and complexity of the stones.

3. Pain Management:

• You may experience some discomfort or pain, managed with pain medications.

4. Fluid Intake:

• You will be encouraged to drink plenty of water to flush out any residual fragments.

5. Follow-up Imaging:

• X-rays or CT scans may be performed to ensure complete stone removal.

6. Recovery at Home:

• You will receive discharge instructions, including activity restrictions and medication guidelines.

7. Follow-up Appointments:

• Scheduled follow-ups with your urologist to monitor your recovery and address concerns.

ECIRS Recovery Time:

• The procedure usually takes 3 to 4 hours.
• Post-surgery, you may feel pain or discomfort in your back or side and may notice blood in your urine.
• You will stay in the hospital for 1 to 2 nights for monitoring.

ECIRS Side Effects:

1. Bleeding: Potential for bleeding during or after surgery, occasionally requiring transfusions.
2. Infection: Risk of kidney or tissue infections despite prophylactic antibiotics.
3. Pneumothorax or Pleural Injury: Rare risk of lung lining injury (pneumothorax).
4. Organ Injury: Rare injury to nearby organs such as bowel, spleen, or liver.
5. Postoperative Pain: Manageable with pain relief medications.
6. Allergic Reactions: Possible reactions to anaesthesia or medications.
7. Cardiovascular Events: Rare cardiovascular issues, especially in patients with pre-existing conditions.

Why Choose Genesis Superspeciality Hospital for ECIRS?

Genesis Superspeciality Hospital prioritizes patient safety, comfort, and satisfaction throughout the treatment process. Dr. Raju R. has a proven record of successful outcomes and substantial expertise in Endoscopic Combined Intrarenal Surgery. Our facility offers competitive pricing, prompt surgical scheduling, and minimizes patient wait times.