DOI: 10.29188/2222-8543-2026-19-1-72-81
For citation:
Martov A.G., Tokhtiyev Z.T., Andronov A.S., Dutov S.V., Adilhanov M.M., Zavarzin D.Y., Yahyaev E.K., Zabrodina N.B. Endoscopic combined intrarenal surgery for multiple and staghorn renal stones using micro-, mini-percutaneous approaches and various suction techniques. Experimental and Clinical Urology 2026;19(1):72-81; https://doi.org/10.29188/2222-8543-2026-19-1-72-81
Martov A.G., Tokhtiyev Z.T., Andronov A.S., Dutov S.V., Adilhanov M.M., Zavarzin D.Y., Yahyaev E.K., Zabrodina N.B.
Information about authors:
- Martov A.G. – Dr. Sci., professor, corresp. member of the RAS, Head of the Department of Urology and Andrology of Medical and Biological University of Innovation and Continuous Education of Federal Medical Biophysical Center named after A.I. Burnazyan of Federal Medical and Biological Agency of Russia, Head of the Urology Center of the Central Clinical Hospital of Civil Aviation, eading researcher at the Medical Scientific and Educational Center of Lomonosov Moscow State University, director of urological center at the Central clinical hospital of Civil aviation, Moscow, Russia; RSCI Author ID: 788667, https://orcid.org/0000-0001-6324-6110
- Tokhtiev T. Z. – Postgrad. Student at the Department of Urology and Andrology of Medical and Biological University of Innovation and Continuous Education of Federal Medical Biophysical Center named after A.I. Burnazyan of Federal Medical and Biological Agency of Russia Moscow, Russia; https://orcid.org/0009-0001-5037-1227
- Andronov A.S. – PhD, Assoc. professor at the Department of Urology and Andrology of Medical and Biological University of Innovation and Continuous Education of Federal Medical Biophysical Center named after A.I. Burnazyan of Federal Medical and Biological Agency of Russia Moscow, head of the urological department №1 at the urological center at the Central clinical hospital of Civil Aviation, Moscow, Russia; RSCI Author ID: 1141939, https://orcid.org/0000-0002-5492-6808
- Dutov S.V. – PhD, Assoc. professor at the Department of Urology and Andrology of Medical and Biological University of Innovation and Continuous Education of Federal Medical Biophysical Center named after A.I. Burnazyan of Federal Medical and Biological Agency of Russia; urologist at the urological department №1 at the urological center at the Central clinical hospital of Civil Aviation, Moscow, Russia; RSCI Author ID: 722683, https://orcid.org/0000-0002-5384-355X
- Adilkhanov M.M. – urologist at the urological department №1 urological center at the Central clinical hospital of Civil Aviation, Moscow, Russia; https://orcid.org/0000-0003-2282-8645
- Zavarzin D.Yu. – Resident at the Department of Urology and Andrology of Medical and Biological University of Innovation and Continuous Education of Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia; https://orcid.org/0009-0006-1054-5460
- Yakhyaev E.К. – Postgrad. Student at the Department of Urology and Andrology of Medical
and Biological University of Innovation and Continuous Education of Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia; https://orcid.org/0009-0007-9657-3418
- Zabrodina N.B. – Dr. Sci., Head of the Central clinical hospital of Civil Aviation, head of Department of Aviaton and Space Medicine of Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia; RSCI Author ID: 1182707, https://orcid.org/0000-0002-8509-5103
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Introduction. The management of complex stone disease remains a major challenge in contemporary urology. In recent years, growing interest has been directed toward endoscopic combined intrarenal surgery (ECIRS), which integrates retrograde and antegrade approaches. At the same time, successful ECIRS requires careful preoperative planning and thorough operating room setup, including optimal positioning of the fluoroscopic C-arm, two endoscopic systems, two laser lithotripters, and two instrument sets to ensure effective coordination between the operating surgeons. Despite the increasing use of this technique, the respective strengths and limitations of different ECIRS approaches in patients with multiple and staghorn renal stones have not yet been sufficiently clarified.
Objective. To evaluate the efficacy and safety of micropercutaneous endoscopic combined intrarenal surgery (micro-ECIRS), minipercutaneous endoscopic combined intrarenal surgery (mini-ECIRS), and suction-assisted mini-ECIRS (suction-mini ECIRS) in patients with multiple and/or staghorn renal stones, and to compare outcomes with mini-percutaneous nephrolithotomy (mini-PCNL).
Materials and methods. A single-center prospective nonrandomized comparative study (2023–2025) conducted within one department using a unified protocol, surgical team, and equipment across two clinical sites (Pletnev City Clinical Hospital and the Central Clinical Hospital of Civil Aviation). A total of 101 patients were included: endoscopic combined intrarenal surgery (ECIRS) (n=63; micro-ECIRS n=24, mini-ECIRS n=29, suction-mini ECIRS n=10) and a control mini-PCNL group (n=38). Stone complexity was assessed using Guy’s Stone Score (GSS) II–IV. Endpoints included stone-free rate (SFR), operative time, hemoglobin drop, Clavien–Dindo complications, length of stay and residual fragments grading.
Results. SFR was high across all techniques, with no intergroup differences in SFR. Complications were limited to Clavien–Dindo grade I–II; no grade ≥III events were recorded. Operative time, hemoglobin decrease, and length of stay differed between approaches. The suction-mini ECIRS subgroup demonstrated technical feasibility and safety.
Conclusion. Micro-, mini-, and suction-mini ECIRS provide high efficacy and an acceptable safety profile for multiple and staghorn renal stones and may be considered suitable options.
