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      The role of ureteroscopy for treatment of staghorn calculi: A systematic review

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          To define the role of ureteroscopy for treatment of staghorn calculi.


          A systematic review was conducted using the Scopus and Medline databases. Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.


          In five studies on ureteroscopic monotherapy, stone-free rate (SFR) ranged from 33% to 93%, with a maximum four ureteroscopy sessions per patient and no major complications. Endoscopic combined intrarenal surgery (ECIRS) was compared with percutaneous nephrolithotomy (PNL) in two studies and reached significantly higher SFR (88%–91% vs. 59%–65%) and lower operative times (84–110 min vs. 105–129 min). The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%–89%. One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi, with a SFR of 92%.


          Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi. Ureteroscopy is also particularly suitable for clearance of residual stones. In specific cases, ureteroscopy may become the sole applicable therapeutic option to staghorn calculi. Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.

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          Most cited references 47

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          Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations.

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            Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy?

            Percutaneous nephrolithotomy (PCNL), the gold standard for the management of large and/or complex urolithiasis, is conventionally performed with the patient in the prone position, which has several drawbacks. Of the various changes in patient positioning proposed over the years, the Galdakao-modified supine Valdivia (GMSV) position seems the most beneficial. It allows simultaneous performance of PCNL and retrograde ureteroscopy (ECIRS, Endoscopic Combined Intra-Renal Surgery) and has unquestionable anaesthesiological advantages. To prospectively analyse the safety and efficacy of endoscopic combined intrarenal surgery (ECIRS) in GMSV position for the treatment of large and/or complex urolithiasis. From April 2004 to December 2007, 127 consecutive patients who were followed in our department for large and/or complex urolithiasis were selected for surgery (American Society of Anesthesiologists [ASA] score 1-3, no active urinary tract infection [UTI], any body mass index [BMI]). All the patients underwent ECIRS in GMSV position. Technical choices about percutaneous access, endoscopic instruments and accessories, and postoperative renal and ureteral drainage are detailed. Patients' mean age plus or minus standard deviation (+/- SD) was 53.1 yr+/-14.2. Of the 127 patients, 5.5% had congenital renal abnormalities, 3.9% had solitary kidneys, and 60.6% were symptomatic for renal colics, haematuria, and recurrent UTI. Mean stone size+/-SD was 23.8mm+/-7.3 (range: 11-40); 33.8% of the calculi were calyceal, 33.1% were pelvic, 33.1% were multiple or staghorn, and 4.7% were also ureteral. Mean operative time+/-SD was 70min+/-28, including patient positioning. Stone-free rate was 81.9% after the first treatment and was 87.4% after a second early treatment using the same percutaneous access during the same hospital stay (mean+/-SD: 5.1 d+/-2.9). We registered overall complications at 38.6% with no splanchnic injuries or deaths and no perioperative anaesthesiological problems. ECIRS performed in GMSV position seems to be a safe, effective, and versatile procedure with a high one-step stone-free rate, unquestionable anaesthesiological advantages, and no additional procedure-related complications.
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              Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access.


                Author and article information

                Asian J Urol
                Asian J Urol
                Asian Journal of Urology
                Second Military Medical University
                05 December 2019
                April 2020
                05 December 2019
                : 7
                : 2
                : 110-115
                [a ]Sorbonne Université, Service d’Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France
                [b ]Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France
                [c ]Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
                [d ]Department of Urology, AZ Klina, Brasschaat, Belgium
                Author notes
                []Corresponding author. Sorbonne Université, Service d’Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France. olivier.traxer@

                These authors contributed equally.

                © 2020 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (

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