Objective To evaluate the efcacy and safety of endoscopic combined intrarenal surgery (ECIRS) in the Galdakao-Modifed
Supine Valdivia (GMSV) position versus percutaneous nephrolithotomy (PCNL) in the prone position for managing complex
kidney stones.
Methods This prospective, randomized study was conducted in the urology departments of Benha University Hospital and
Theodor Bilharz Research Institute between June 2021 and May 2024. A total of 60 patients with complex renal stones were
randomly assigned to two groups (30 patients each). Group A underwent conventional percutaneous nephrolithotomy (PCNL)
in the prone position, while Group B underwent endoscopic combined intrarenal surgery (ECIRS) in the Galdakao-Modifed
Supine Valdivia (GMSV) position. Data on demographic characteristics, clinical outcomes, perioperative parameters, and
stone-free rates (SFR) were collected.
Results No signifcant diferences were found between the two groups regarding preoperative demographic data and stone
characteristics. However, operative time was signifcantly longer in the PCNL group (119±18 min) compared to the ECIRS
group (105±14 min) (P=0.002). The number of punctures was also signifcantly higher in the PCNL group than in the
ECIRS group (P=0.001). Immediate success was notably higher in the ECIRS group (83.3%) compared to the PCNL group
(53.3%) (P=0.012). However, no signifcant diference was observed between the groups concerning eventual success
(P=1.0).
Conclusion ECIRS is a highly efective treatment for complex renal stones, delivering favorable outcomes such as higher
single-step stone-free rates, a lower incidence of adverse events, and a reduced need for auxiliary procedures.