Impacts of urinary tract anomalies or history of upper urinary tract surgery on outcome of mini-ECIRS (Endoscopic Combined Intrarenal Surgery)

Impacts of urinary tract anomalies or history of upper urinary tract surgery on outcome of mini-ECIRS (Endoscopic Combined Intrarenal Surgery) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impacts of urinary tract anomalies or history of upper urinary tract surgery on outcome of mini-ECIRS (Endoscopic Combined Intrarenal Surgery) Yosuke Shibata, Hiroki Ito, Tetsuo Fukuda, Fukashi Yamamichi, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4351715/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Oct, 2024 Read the published version in Urolithiasis → Version 1 posted 8 You are reading this latest preprint version Abstract This study assessed the impact of urinary tract anomalies or a history of upper urinary tract surgery (UTAS) on the minimally invasive endoscopic combined intrarenal surgery (mini-ECIRS) outcomes. Data from 1432 patients undergoing ECIRS for urolithiasis at three Japanese tertiary institutions between 2015 and 2021 were analyzed, with patients categorized into those with normal urinary tracts (non-UTAS) and those with UTAS (UTAS). We retrospectively examined the association between the UTAS and perioperative outcomes in mini-ECIRS. Of the 1096 cases in the final analysis, 1035 and 61 were identified as non-UTAS and UTAS, respectively. Stone-free rate (residual fragments > 2 mm, 62.8% vs. 62.7%), operation time (110.5 vs. 115.0 minutes), and hospital stay duration (5.6 vs. 5.7 days) showed no significant differences between non-UTAS and UTAS. The UTAS group demonstrated significantly higher rates of preoperative pyuria (86.2% vs. 71.1%), preoperative urinary tract infection (32.8% vs. 15.5%), preoperative stenting (52.5% vs. 31.0%), and preoperative nephrostomy (24.6% vs. 9.2%). However, the postoperative fever (26.3% vs. 25.0%) or septic shock (1.9% vs. 0%) were comparable between non-UTAS and UTAS. Stone burden and the number of calyces involved were significantly associated with a low stone-free rate (P < 0.001). Younger age, female sex, solitary stones, number of calyces involved, preoperative urinary tract infection, and absence of preoperative nephrostomy were identified as risk factors for perioperative complications. The UTAS was not associated with stone-free outcomes or perioperative complications. Mini-ECIRS demonstrated comparable stone-free outcomes and safety in patients with UTAS and those with normal urinary tracts. complications mini-endoscopic combined intrarenal surgery renal stones stone free rates ureteral stones urinary tract anomalies Figures Figure 1 Introduction Endoscopic combined intrarenal surgery (ECIRS) is a surgical technique for urinary stones involving the simultaneous use of flexible retrograde ureteroscopy (URS) and percutaneous nephrolithotomy (PNL) [ 1 ]. Mini-ECIRS using a thinner percutaneous access tract provides ECIRS less invasively, becoming the standard procedure for large and complicated urolithiasis. Compared with conventional ECIRS with a stone-free rate (SFR) of 52.0%, mini-ECIRS demonstrates an equivalent SFR of 61.1% and a potential decrease in postoperative complications related to pain and bleeding [ 2 ]. Patients with urinary tract anomalies or a history of upper urinary tract surgery (UTAS) reportedly develop urinary stones because of chronic urinary tract infections and abnormal urodynamics [ 3 , 4 ]. However, the outcomes and management of stones in those patients remain unclear [ 5 ]. UTAS may increase surgical difficulty and negatively impact clinical outcomes; thus, we hypothesized that mini-ECIRS may be a reasonable treatment option for these patients, owing to its utility and feasibility for complicated stones. Although the difficulty of ECIRS depends on several clinical parameters, including the number of calyces with stone and stone burden [ 6 , 7 ], the impact of UTAS on mini-ECIRS outcomes remains unreported. This study compiled the largest ECIRS cohorts from three high-volume centers in Japan and retrospectively investigated the effect of UTAS on stone-free outcomes and perioperative complications in mini-ECIRS. Patients and Methods We enrolled 1432 patients who underwent conventional or mini-ECIRS for urinary stone disease at three high-volume centers in Japan (Yokosuka Kyosai Hospital, Ohguchi East General Hospital, and Hara Genitourinary Hospital) between 2015 and 2021. The inclusion criterion was single-session mini-ECIRS for renal and/or ureteral stones. The exclusion criteria were procedures with renal access tracts larger than 18Fr and preoperatively intended staged procedures. Patients were divided into two groups: those with a normal urinary tract (non-UTAS) and those with UTAS (UTAS). UTAS included cases of urinary diversion (ileal conduit, neobladder), history of upper urinary tract surgery, vesicoureteral reflux (VUR), ureteral stricture, ureteropelvic junction obstruction (UPJO), transplanted kidney, horseshoe kidney, pelvic kidney, sponge kidney, and atrophic kidney. The evaluation was conducted with a computed tomography scan one month after performing mini-ECIRS, defining stone-free (SF) as no residual stone entirely or residual stone fragments ≤ 2 mm. Residual urinary stone fragments of > 2 mm were defined as non-SFs. Statistical analysis Basic patient characteristics comparison and perioperative outcomes between the groups were analyzed using Student’s t-test and the chi-square test. Logistic regression analysis was used to estimate the odds ratios (ORs) of SF and perioperative complications. For multivariate logistic regression analysis of SF and perioperative complications, variables were selected using the backward stepwise selection method based on the following clinical factors: age, sex, body mass index (BMI), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), stone laterality, stone position (with or without R2 stone), number of stones (solitary or multiple), stone burden (sum of the largest stone diameters), number of calyces involved, presence of urinary tract anomalies, history of preoperative urinary tract infection (UTI) defined as that of preoperative stone-related pyelonephritis, hydronephrosis, preoperative stenting, preoperative stenting, and preoperative nephrostomy. All P-values were two-sided, with the significance level set at 0.05. Statistical analyses were performed using EZR (version 3.5.2; https://www.jichi.ac.jp/saitama-sct/SaitamaHP files/statmedEN. html) and R (version 4.2.3; https://www.r-project.org/ ). Results A total of 1,432 ECIRS cases conducted at three institutions were registered, with 1,374 cases identified as mini-ECIRS cases. Of the 1,374 mini-ECIRS, 278 procedures consisting of 7 UTAS and 271 non-UTAS, were excluded due to intended preoperative staged ECIRS, resulting in the analysis of 1096 cases for this study (Fig. 1 ). The mini-ECIRS for patients with UTAS consisted of 61 cases, whereas that for non-UTAS comprised 1035 cases.Of the 61 patients with UTAS, 31 (51%) had urinary tract anomalies, and 30 (49%) had an upper urinary tract surgery history (Table 1). Table 2 presents the patient backgrounds in each group. The number of stones (3.4 ± 2.9 vs. 2.8 ± 2.2, P = 0.025), preoperative pyuria (86.2% vs. 71.1%, P = 0.013), preoperative UTI (32.8% vs. 15.5%, P < 0.001), preoperative stenting (52.5% vs. 31.0%, P < 0.001), and preoperative nephrostomy (24.6% vs. 9.2%, P < 0.001) were significantly higher in UTAS than in non-UTAS. The perioperative outcomes are summarized in Table 3. Operation Time (110.5 ± 33.9 vs. 115.0 ± 40.6), postoperative hospital stays (5.6 ± 3.1 vs. 5.7 ± 2.5), SFR (62.8% vs. 62.7%), stone components, postoperative stenting (65.2% vs 67.2%), postoperative nephrostomy (72.9% vs. 70.5%), and any complications showed no significant differences between non-UTAS and UTAS. The preoperative hemoglobin level was significantly lower in the UTAS group (P = 0.018) than in the non-UTAS group. However, the postoperative 1-day drop in hemoglobin level was significantly greater in the non-UTAS group (P = 0.026). Age, sex, BMI, ECOG-PS, stone laterality, stone position (with or without R2 stones), number of stones, stone burden, number of involved calyces, presence of urinary tract anomalies, preoperative UTI, presence of hydronephrosis, preoperative stenting, and preoperative nephrostomy were selected and included in the multivariate logistic regression analysis models for SF (Table 4) and perioperative complications (Table 5). The stone burden and number of involved calyces were significantly associated with a lower SF (P < 0.001) (Table 4). Younger age (P = 0.004), female sex (P < 0.001), solitary stones (P = 0.013), number of involved calyces (P < 0.001), preoperative UTI (P = 0.044), and absence of preoperative nephrostomy (P < 0.001) were identified as risk factors for perioperative complications (Table 5). Discussion UTAS may increase urolithiasis-related problems, and knowledge regarding the treatment and management of these patients is evidently lacking. Although the stone characteristics in patients with UTAS seem complicated, leading to worse surgical outcomes, this multicenter retrospective analysis demonstrated that mini-ECIRS is a highly feasible and safe surgical option even for patients with UTAS without compromising treatment outcomes. To our knowledge, the present study is the first to investigate the utility and feasibility of mini-ECIRS in patients with UTAS. Urinary stasis resulting from anatomical abnormalities promotes urinary stone formation by causing a delayed washout of crystal aggregates and urinary tract infections [ 4 ]. In this study, the UTAS group showed a higher stone number and more frequent infectious stones than the non-UTAS group, with no difference in stone burden. Among the ten cases of ileal conduit, the most common type in this study's UTAS, seven cases included infectious stones as components. Patients with UTAS exhibited a higher prevalence of preoperative pyuria and UTI, suggesting an increased number of cases requiring preoperative stenting and nephrostomy for UTI management. Congenital anomalies of the kidney and urinary tract have been reported to permit the effective use of URS [ 8 – 10 ] and PCNL [ 11 – 13 ], achieving a satisfactory SFR with low-risk complications. In terms of reports on stone surgeries in patients with a history of urinary tract surgery, only one retrospective study has compared PNL and URS in patients with an ileal conduit [ 14 ]. This study indicated that the SFR on the mini-ECIRS was equivalent between the non-UTAS (62.8%) and UTAS (62.7%) groups. UTAS did not prolong the surgical time of mini-ECIRS, although anatomical abnormalities may increase surgical difficulty. In the UTAS group, the higher proportion of preoperative stenting and nephrostomy may have simplified surgical techniques, potentially resulting in no significant difference in surgical time. The multivariable model also showed UTAS did not directly contribute to the SFR, and stone burden and the number of involved calyces were identified as risk factors for non-SF, as previously well reported [ 6 , 7 , 15 ]. The overall complication rate was not significantly different between the non-UTAS (29.6%) and UTAS (29.5%) groups. Fever/SIRS was the most frequently observed complication, followed by septic shock, organ injury, and renal vascular complications, and no significant difference was observed between the groups for each complication. UTAS was not a significant risk factor for perioperative complications, including infectious and bleeding-related events, and did not contribute to an increase in these complications. Thus, our study revealed that mini-ECIRS can be safely performed in patients with comparable complication rates comparable to those in patients without UTAS. In this study, preoperative UTI, female sex, and number of calyces involved were identified as risk factors for perioperative complications of mini-ECIRS, as previously reported for ECIRS [ 15 , 16 ] or mini-PCNL [ 17 ]. Additionally, preoperative nephrostomy reduces the complication risks. Preoperative nephrostomy is a well-known procedure that reduces the risk of severe infectious complications [ 18 , 19 ] and bleeding [ 18 ] in PCNL. Preoperative nephrostomy facilitates drainage, suppresses intrapelvic pressure, and shortens the surgical procedure for ECIRS. In this cohort, compared with non-UTAS patients, those with UTAS had a higher implantation rate for preoperative nephrostomy. This may explain the finding that UTAS was not an independent predictor of perioperative complications in the present study, although patients with UTAS tended to have a preoperative urinary tract infection history. Therefore, proactive measures, such as preoperative nephrostomy, may be important in managing UTAS patients with UTI. This study had several limitations. It is retrospective in nature, involves multiple centers, leading to variations in surgical approaches due to diverse operators, and may exhibit potential selection bias in cases of UTAS, where less invasive procedures, such as URS, could be preferred based on clinical judgment. The number of patients with UTAS was relatively small, which may have resulted in poor statistical power to obtain proper significance. Conclusions Mini-ECIRS for patients with UTAS demonstrated stone-free and complication rates comparable to those of patients with a normal urinary tract, affirming its safety and efficacy. However, a history of UTI, a risk factor for complications, was more prevalent in patients with UTAS. Therefore, proactive measures, such as preoperative nephrostomy, may be important in managing UTAS patients with UTI. The results of this study suggest that mini-ECIRS is a safe and valuable surgical option for stone treatment in patients with UTAS. Abbreviations UTAS urinary tract anomalies or a history of upper urinary tract surgery ECIRS Endoscopic Combined Intrarenal Surgery Mini-ECIRS minimally invasive Endoscopic Combined Intrarenal Surgery URS ureteroscopy PNL percutaneous nephrolithotomy SF stone-free SFR stone-free rate VUR vesicoureteral reflux UPJO ureteropelvic junction obstruction BMI body mass index ECOG-PS Eastern Cooperative Oncology Group Performance Status UTI Urinary tract infection Declarations Acknowledgements We thank Editage (www.editage.com) for the English language editing. Author contributions Y.S.: Writing—original draft, writing —review and editing, formal analysis, methodology. H.I.: Writing-review and editing, Conceptualization, Formal analysis, methodology. T.F., F.Y., and T.W.: Data curation. T.T., T.I., J.M., and K.K.: Supervision. The first draft of the manuscript was written by Y.S., and all authors commented on previous versions of the manuscript. All the authors have read and approved the final version of the manuscript. Ethics declarations Funding No funding was received for conducting this study. Conflicts of interest The authors declare no competing interests relevant to the contents of this article. Ethical approval statement This study was approved by the Ethics Committees of Yokosuka Kyosai Hospital (#20-90), Ohguchi East General Hospital (#202201), and Hara Genitourinary Hospital (#2021-05-06) in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent to participate and publication Informed consent was obtained from all individual participants included in the study. Data availability statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. References Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol 54(6):1393–1403. https://doi.org/10.1016/j.eururo.2008.07.073 Usui K, Komeya M, Taguri M, Kataoka K, Asai T, Ogawa T, Yao M, Matsuzaki J (2020) Minimally invasive versus standard endoscopic combined intrarenal surgery for renal stones: a retrospective pilot study analysis. 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Minerva Urol Nephrol 75(5):616–624. https://doi.org/10.23736/s2724-6051.23.05394-6 Yamashita S, Kohjimoto Y, Iba A, Kikkawa K, Hara I (2017) Stone size is a predictor for residual stone and multiple procedures of endoscopic combined intrarenal surgery. Scand J Urol 51(2):159–164. https://doi.org/10.1080/21681805.2017.1284897 Tabei T, Ito H, Usui K, Kuroda S, Kawahara T, Terao H, Fujikawa A, Makiyama K, Yao M, Matsuzaki J (2016) Risk factors of systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position. Int J Urol 23(8):687–692. https://doi.org/10.1111/iju.13124 Liu C, Zhang X, Liu Y, Wang P (2013) Prevention and treatment of septic shock following mini-percutaneous nephrolithotomy: a single-center retrospective study of 834 cases. World J Urol 31(6):1593–1597. https://doi.org/10.1007/s00345-012-1002-2 Zhao Z, Wu W, Zeng T, Wu X, Liu Y, Zeng G (2021) The impact of nephrostomy drainage prior to mini-percutaneous nephrolithotomy in patients with ESBL-positive Escherichia coli. World J Urol 39(1):239–246. https://doi.org/10.1007/s00345-020-03155-6 Benson AD, Juliano TM, Miller NL (2014) Infectious outcomes of nephrostomy drainage before percutaneous nephrolithotomy compared to concurrent access. J Urol 192(3):770–774. https://doi.org/10.1016/j.juro.2014.03.004 Tables Table 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.xlsx Table 1 Summary of patients with urinary tract anomalies or a history of upper urinary tract surgery Table2.xlsx Table 2 Comparison of basic patients' characteristics in mini-ECIRS between the groups Table3.xlsx Table 3 Comparison of perioperative outcomes in mini-ECIRS between the groups Table4.xlsx Table 4 Univariate and multivariate logistic regression analysis of stone free achievement of mini-ECIRS Table5.xlsx Table 5 Univariate and multivariate logistic regression analysis of complications in mini-ECIRS Cite Share Download PDF Status: Published Journal Publication published 09 Oct, 2024 Read the published version in Urolithiasis → Version 1 posted Editorial decision: Revision requested 20 Jul, 2024 Reviews received at journal 19 Jul, 2024 Reviewers agreed at journal 19 Jul, 2024 Reviewers agreed at journal 09 May, 2024 Reviewers invited by journal 03 May, 2024 Submission checks completed at journal 02 May, 2024 Editor assigned by journal 02 May, 2024 First submitted to journal 30 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4351715","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":299073785,"identity":"8719f024-6dd5-403c-888a-84c50d8ead47","order_by":0,"name":"Yosuke Shibata","email":"","orcid":"","institution":"Yokosuka Kyosai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yosuke","middleName":"","lastName":"Shibata","suffix":""},{"id":299073786,"identity":"2fd4c45f-2630-4ab0-97cf-c6d7d212011f","order_by":1,"name":"Hiroki 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selection\u003c/p\u003e","description":"","filename":"Fig11.png","url":"https://assets-eu.researchsquare.com/files/rs-4351715/v1/741918c3b54189258ad27da4.png"},{"id":66597210,"identity":"bc5bf572-9fc4-422e-b770-25689f220fc4","added_by":"auto","created_at":"2024-10-14 16:08:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":359256,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4351715/v1/e8132b55-e5a4-4a72-982b-65654c05105d.pdf"},{"id":56282693,"identity":"8177fab6-a748-40f0-a85f-5f58bb6f1de3","added_by":"auto","created_at":"2024-05-10 21:35:10","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":10706,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 1 Summary of patients with urinary tract anomalies or a history of upper urinary tract surgery\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Table1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4351715/v1/46c389568f976034162c56a9.xlsx"},{"id":56282600,"identity":"ac697d8e-cd23-4fe4-bde7-a16331f562b5","added_by":"auto","created_at":"2024-05-10 21:34:32","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":11296,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 2 Comparison of basic patients' characteristics in mini-ECIRS between the groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Table2.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4351715/v1/6aeea856e74825f940828514.xlsx"},{"id":56282634,"identity":"1fdf45b5-e5be-4b87-b8f4-be9fa0d292e2","added_by":"auto","created_at":"2024-05-10 21:34:41","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":11748,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 3 Comparison of perioperative outcomes in mini-ECIRS between the groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Table3.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4351715/v1/48d4f7ccce32eacb2c7a5f9e.xlsx"},{"id":56282644,"identity":"a58d1104-464f-496a-8c1f-68009055c5b4","added_by":"auto","created_at":"2024-05-10 21:34:46","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":11698,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 4 Univariate and multivariate logistic regression analysis of stone free achievement of mini-ECIRS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Table4.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4351715/v1/aa3d0db7d170c774d59744fa.xlsx"},{"id":56282495,"identity":"90922b35-e85b-494f-bddf-768045de968b","added_by":"auto","created_at":"2024-05-10 21:33:55","extension":"xlsx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":11734,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 5 Univariate and multivariate logistic regression analysis of complications in mini-ECIRS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Table5.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4351715/v1/b3f4574e20a311a113889a82.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impacts of urinary tract anomalies or history of upper urinary tract surgery on outcome of mini-ECIRS (Endoscopic Combined Intrarenal Surgery)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndoscopic combined intrarenal surgery (ECIRS) is a surgical technique for urinary stones involving the simultaneous use of flexible retrograde ureteroscopy (URS) and percutaneous nephrolithotomy (PNL) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Mini-ECIRS using a thinner percutaneous access tract provides ECIRS less invasively, becoming the standard procedure for large and complicated urolithiasis. Compared with conventional ECIRS with a stone-free rate (SFR) of 52.0%, mini-ECIRS demonstrates an equivalent SFR of 61.1% and a potential decrease in postoperative complications related to pain and bleeding [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with urinary tract anomalies or a history of upper urinary tract surgery (UTAS) reportedly develop urinary stones because of chronic urinary tract infections and abnormal urodynamics [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, the outcomes and management of stones in those patients remain unclear [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. UTAS may increase surgical difficulty and negatively impact clinical outcomes; thus, we hypothesized that mini-ECIRS may be a reasonable treatment option for these patients, owing to its utility and feasibility for complicated stones. Although the difficulty of ECIRS depends on several clinical parameters, including the number of calyces with stone and stone burden [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], the impact of UTAS on mini-ECIRS outcomes remains unreported.\u003c/p\u003e \u003cp\u003eThis study compiled the largest ECIRS cohorts from three high-volume centers in Japan and retrospectively investigated the effect of UTAS on stone-free outcomes and perioperative complications in mini-ECIRS.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003eWe enrolled 1432 patients who underwent conventional or mini-ECIRS for urinary stone disease at three high-volume centers in Japan (Yokosuka Kyosai Hospital, Ohguchi East General Hospital, and Hara Genitourinary Hospital) between 2015 and 2021. The inclusion criterion was single-session mini-ECIRS for renal and/or ureteral stones. The exclusion criteria were procedures with renal access tracts larger than 18Fr and preoperatively intended staged procedures.\u003c/p\u003e \u003cp\u003ePatients were divided into two groups: those with a normal urinary tract (non-UTAS) and those with UTAS (UTAS). UTAS included cases of urinary diversion (ileal conduit, neobladder), history of upper urinary tract surgery, vesicoureteral reflux (VUR), ureteral stricture, ureteropelvic junction obstruction (UPJO), transplanted kidney, horseshoe kidney, pelvic kidney, sponge kidney, and atrophic kidney.\u003c/p\u003e \u003cp\u003eThe evaluation was conducted with a computed tomography scan one month after performing mini-ECIRS, defining stone-free (SF) as no residual stone entirely or residual stone fragments\u0026thinsp;\u0026le;\u0026thinsp;2 mm. Residual urinary stone fragments of \u0026gt;\u0026thinsp;2 mm were defined as non-SFs.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eBasic patient characteristics comparison and perioperative outcomes between the groups were analyzed using Student\u0026rsquo;s t-test and the chi-square test. Logistic regression analysis was used to estimate the odds ratios (ORs) of SF and perioperative complications. For multivariate logistic regression analysis of SF and perioperative complications, variables were selected using the backward stepwise selection method based on the following clinical factors: age, sex, body mass index (BMI), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), stone laterality, stone position (with or without R2 stone), number of stones (solitary or multiple), stone burden (sum of the largest stone diameters), number of calyces involved, presence of urinary tract anomalies, history of preoperative urinary tract infection (UTI) defined as that of preoperative stone-related pyelonephritis, hydronephrosis, preoperative stenting, preoperative stenting, and preoperative nephrostomy. All P-values were two-sided, with the significance level set at 0.05. Statistical analyses were performed using EZR (version 3.5.2; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.jichi.ac.jp/saitama-sct/SaitamaHP\u003c/span\u003e\u003cspan address=\"https://www.jichi.ac.jp/saitama-sct/SaitamaHP\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e files/statmedEN. html) and R (version 4.2.3; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.r-project.org/\u003c/span\u003e\u003cspan address=\"https://www.r-project.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 1,432 ECIRS cases conducted at three institutions were registered, with 1,374 cases identified as mini-ECIRS cases. Of the 1,374 mini-ECIRS, 278 procedures consisting of 7 UTAS and 271 non-UTAS, were excluded due to intended preoperative staged ECIRS, resulting in the analysis of 1096 cases for this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe mini-ECIRS for patients with UTAS consisted of 61 cases, whereas that for non-UTAS comprised 1035 cases.Of the 61 patients with UTAS, 31 (51%) had urinary tract anomalies, and 30 (49%) had an upper urinary tract surgery history (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;2 presents the patient backgrounds in each group. The number of stones (3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 vs. 2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2, P\u0026thinsp;=\u0026thinsp;0.025), preoperative pyuria (86.2% vs. 71.1%, P\u0026thinsp;=\u0026thinsp;0.013), preoperative UTI (32.8% vs. 15.5%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), preoperative stenting (52.5% vs. 31.0%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and preoperative nephrostomy (24.6% vs. 9.2%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly higher in UTAS than in non-UTAS.\u003c/p\u003e \u003cp\u003eThe perioperative outcomes are summarized in Table\u0026nbsp;3. Operation Time (110.5\u0026thinsp;\u0026plusmn;\u0026thinsp;33.9 vs. 115.0\u0026thinsp;\u0026plusmn;\u0026thinsp;40.6), postoperative hospital stays (5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 vs. 5.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5), SFR (62.8% vs. 62.7%), stone components, postoperative stenting (65.2% vs 67.2%), postoperative nephrostomy (72.9% vs. 70.5%), and any complications showed no significant differences between non-UTAS and UTAS. The preoperative hemoglobin level was significantly lower in the UTAS group (P\u0026thinsp;=\u0026thinsp;0.018) than in the non-UTAS group. However, the postoperative 1-day drop in hemoglobin level was significantly greater in the non-UTAS group (P\u0026thinsp;=\u0026thinsp;0.026).\u003c/p\u003e \u003cp\u003eAge, sex, BMI, ECOG-PS, stone laterality, stone position (with or without R2 stones), number of stones, stone burden, number of involved calyces, presence of urinary tract anomalies, preoperative UTI, presence of hydronephrosis, preoperative stenting, and preoperative nephrostomy were selected and included in the multivariate logistic regression analysis models for SF (Table\u0026nbsp;4) and perioperative complications (Table\u0026nbsp;5). The stone burden and number of involved calyces were significantly associated with a lower SF (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;4). Younger age (P\u0026thinsp;=\u0026thinsp;0.004), female sex (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), solitary stones (P\u0026thinsp;=\u0026thinsp;0.013), number of involved calyces (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), preoperative UTI (P\u0026thinsp;=\u0026thinsp;0.044), and absence of preoperative nephrostomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were identified as risk factors for perioperative complications (Table\u0026nbsp;5).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUTAS may increase urolithiasis-related problems, and knowledge regarding the treatment and management of these patients is evidently lacking. Although the stone characteristics in patients with UTAS seem complicated, leading to worse surgical outcomes, this multicenter retrospective analysis demonstrated that mini-ECIRS is a highly feasible and safe surgical option even for patients with UTAS without compromising treatment outcomes. To our knowledge, the present study is the first to investigate the utility and feasibility of mini-ECIRS in patients with UTAS.\u003c/p\u003e \u003cp\u003eUrinary stasis resulting from anatomical abnormalities promotes urinary stone formation by causing a delayed washout of crystal aggregates and urinary tract infections [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this study, the UTAS group showed a higher stone number and more frequent infectious stones than the non-UTAS group, with no difference in stone burden. Among the ten cases of ileal conduit, the most common type in this study's UTAS, seven cases included infectious stones as components. Patients with UTAS exhibited a higher prevalence of preoperative pyuria and UTI, suggesting an increased number of cases requiring preoperative stenting and nephrostomy for UTI management.\u003c/p\u003e \u003cp\u003eCongenital anomalies of the kidney and urinary tract have been reported to permit the effective use of URS [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and PCNL [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], achieving a satisfactory SFR with low-risk complications. In terms of reports on stone surgeries in patients with a history of urinary tract surgery, only one retrospective study has compared PNL and URS in patients with an ileal conduit [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This study indicated that the SFR on the mini-ECIRS was equivalent between the non-UTAS (62.8%) and UTAS (62.7%) groups. UTAS did not prolong the surgical time of mini-ECIRS, although anatomical abnormalities may increase surgical difficulty. In the UTAS group, the higher proportion of preoperative stenting and nephrostomy may have simplified surgical techniques, potentially resulting in no significant difference in surgical time. The multivariable model also showed UTAS did not directly contribute to the SFR, and stone burden and the number of involved calyces were identified as risk factors for non-SF, as previously well reported [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe overall complication rate was not significantly different between the non-UTAS (29.6%) and UTAS (29.5%) groups. Fever/SIRS was the most frequently observed complication, followed by septic shock, organ injury, and renal vascular complications, and no significant difference was observed between the groups for each complication. UTAS was not a significant risk factor for perioperative complications, including infectious and bleeding-related events, and did not contribute to an increase in these complications. Thus, our study revealed that mini-ECIRS can be safely performed in patients with comparable complication rates comparable to those in patients without UTAS.\u003c/p\u003e \u003cp\u003eIn this study, preoperative UTI, female sex, and number of calyces involved were identified as risk factors for perioperative complications of mini-ECIRS, as previously reported for ECIRS [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] or mini-PCNL [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, preoperative nephrostomy reduces the complication risks. Preoperative nephrostomy is a well-known procedure that reduces the risk of severe infectious complications [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and bleeding [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] in PCNL. Preoperative nephrostomy facilitates drainage, suppresses intrapelvic pressure, and shortens the surgical procedure for ECIRS. In this cohort, compared with non-UTAS patients, those with UTAS had a higher implantation rate for preoperative nephrostomy. This may explain the finding that UTAS was not an independent predictor of perioperative complications in the present study, although patients with UTAS tended to have a preoperative urinary tract infection history. Therefore, proactive measures, such as preoperative nephrostomy, may be important in managing UTAS patients with UTI.\u003c/p\u003e \u003cp\u003eThis study had several limitations. It is retrospective in nature, involves multiple centers, leading to variations in surgical approaches due to diverse operators, and may exhibit potential selection bias in cases of UTAS, where less invasive procedures, such as URS, could be preferred based on clinical judgment. The number of patients with UTAS was relatively small, which may have resulted in poor statistical power to obtain proper significance.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eMini-ECIRS for patients with UTAS demonstrated stone-free and complication rates comparable to those of patients with a normal urinary tract, affirming its safety and efficacy. However, a history of UTI, a risk factor for complications, was more prevalent in patients with UTAS. Therefore, proactive measures, such as preoperative nephrostomy, may be important in managing UTAS patients with UTI. The results of this study suggest that mini-ECIRS is a safe and valuable surgical option for stone treatment in patients with UTAS.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUTAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eurinary tract anomalies or a history of upper urinary tract surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eECIRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndoscopic Combined Intrarenal Surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMini-ECIRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eminimally invasive Endoscopic Combined Intrarenal Surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eURS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eureteroscopy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePNL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epercutaneous nephrolithotomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estone-free\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSFR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estone-free rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVUR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003evesicoureteral reflux\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUPJO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eureteropelvic junction obstruction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eECOG-PS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEastern Cooperative Oncology Group Performance Status\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Editage (www.editage.com) for the English language editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.S.: Writing\u0026mdash;original draft, writing \u0026mdash;review and editing, formal analysis, methodology. H.I.: Writing-review and editing, Conceptualization, Formal analysis, methodology. T.F., F.Y., and T.W.: Data curation. T.T., T.I., J.M., and K.K.: Supervision. The first draft of the manuscript was written by Y.S., and all authors commented on previous versions of the manuscript. All the authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests relevant to the contents of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committees of Yokosuka Kyosai Hospital (#20-90), Ohguchi East General Hospital (#202201), and Hara Genitourinary Hospital (#2021-05-06) in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate and publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eScoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? 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World J Urol 39(1):239\u0026ndash;246. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00345-020-03155-6\u003c/span\u003e\u003cspan address=\"10.1007/s00345-020-03155-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenson AD, Juliano TM, Miller NL (2014) Infectious outcomes of nephrostomy drainage before percutaneous nephrolithotomy compared to concurrent access. J Urol 192(3):770\u0026ndash;774. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.juro.2014.03.004\u003c/span\u003e\u003cspan address=\"10.1016/j.juro.2014.03.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"urolithiasis","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ures","sideBox":"Learn more about [Urolithiasis](http://link.springer.com/journal/240)","snPcode":"240","submissionUrl":"https://submission.nature.com/new-submission/240/3","title":"Urolithiasis","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"complications, mini-endoscopic combined intrarenal surgery, renal stones, stone free rates, ureteral stones, urinary tract anomalies","lastPublishedDoi":"10.21203/rs.3.rs-4351715/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4351715/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study assessed the impact of urinary tract anomalies or a history of upper urinary tract surgery (UTAS) on the minimally invasive endoscopic combined intrarenal surgery (mini-ECIRS) outcomes. Data from 1432 patients undergoing ECIRS for urolithiasis at three Japanese tertiary institutions between 2015 and 2021 were analyzed, with patients categorized into those with normal urinary tracts (non-UTAS) and those with UTAS (UTAS). We retrospectively examined the association between the UTAS and perioperative outcomes in mini-ECIRS. Of the 1096 cases in the final analysis, 1035 and 61 were identified as non-UTAS and UTAS, respectively. Stone-free rate (residual fragments\u0026thinsp;\u0026gt;\u0026thinsp;2 mm, 62.8% vs. 62.7%), operation time (110.5 vs. 115.0 minutes), and hospital stay duration (5.6 vs. 5.7 days) showed no significant differences between non-UTAS and UTAS. The UTAS group demonstrated significantly higher rates of preoperative pyuria (86.2% vs. 71.1%), preoperative urinary tract infection (32.8% vs. 15.5%), preoperative stenting (52.5% vs. 31.0%), and preoperative nephrostomy (24.6% vs. 9.2%). However, the postoperative fever (26.3% vs. 25.0%) or septic shock (1.9% vs. 0%) were comparable between non-UTAS and UTAS. Stone burden and the number of calyces involved were significantly associated with a low stone-free rate (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Younger age, female sex, solitary stones, number of calyces involved, preoperative urinary tract infection, and absence of preoperative nephrostomy were identified as risk factors for perioperative complications. The UTAS was not associated with stone-free outcomes or perioperative complications. Mini-ECIRS demonstrated comparable stone-free outcomes and safety in patients with UTAS and those with normal urinary tracts.\u003c/p\u003e","manuscriptTitle":"Impacts of urinary tract anomalies or history of upper urinary tract surgery on outcome of mini-ECIRS (Endoscopic Combined Intrarenal Surgery)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-10 21:18:47","doi":"10.21203/rs.3.rs-4351715/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-20T05:34:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-20T03:51:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207147452536145055163894822371659499864","date":"2024-07-19T12:04:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53043421250676710777309904756730032501","date":"2024-05-09T09:52:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-03T07:42:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-02T08:49:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-02T08:49:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Urolithiasis","date":"2024-04-30T22:58:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"urolithiasis","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ures","sideBox":"Learn more about [Urolithiasis](http://link.springer.com/journal/240)","snPcode":"240","submissionUrl":"https://submission.nature.com/new-submission/240/3","title":"Urolithiasis","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4ab17ee7-ba0a-45d3-97ab-c704fedf51e1","owner":[],"postedDate":"May 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:02:45+00:00","versionOfRecord":{"articleIdentity":"rs-4351715","link":"https://doi.org/10.1007/s00240-024-01638-4","journal":{"identity":"urolithiasis","isVorOnly":false,"title":"Urolithiasis"},"publishedOn":"2024-10-09 15:57:52","publishedOnDateReadable":"October 9th, 2024"},"versionCreatedAt":"2024-05-10 21:18:47","video":"","vorDoi":"10.1007/s00240-024-01638-4","vorDoiUrl":"https://doi.org/10.1007/s00240-024-01638-4","workflowStages":[]},"version":"v1","identity":"rs-4351715","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4351715","identity":"rs-4351715","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}