Mini-ECIRS versus Multiple-Tract Mini-PCNL in the Management of Complex Renal Stones: A Narrative Review

Abstract

Background: Complex renal stones remain a significant challenge in endourological practice because of their large stone burden, involvement of multiple calyces, and complex intrarenal anatomy. Percutaneous nephrolithotomy (PCNL) is an established treatment for large and complex renal calculi; however, complete stone clearance may require multiple access tracts. Multiple-tract mini-PCNL has emerged as an alternative approach that provides direct access to different stone-bearing calyces while using miniaturized instruments to minimize access-related morbidity. Endoscopic combined intrarenal surgery (ECIRS) combines antegrade percutaneous nephroscopy with retrograde flexible ureteroscopy, allowing simultaneous access to different regions of the collecting system. Further miniaturization has led to the development of mini-ECIRS, which aims to achieve effective stone clearance while reducing renal parenchymal injury and the need for additional percutaneous punctures. Nevertheless, the optimal surgical approach for complex renal stones remains controversial, particularly regarding stone-free rates, operative time, blood loss, postoperative complications, and the need for secondary procedures. This review discusses the anatomical rationale, indications, technical principles, and clinical applications of multiple-tract mini-PCNL and mini-ECIRS, highlighting their potential advantages, limitations, and current evidence gaps to support surgical decision-making.