How ECIRS Works: Step-by-Step Breakdown of the Combined Antegrade and Retrograde Technique

Medicine Made Simple Summary

ECIRS, or Endoscopic Combined Intrarenal Surgery, removes complex kidney stones by using two pathways at the same time. One pathway reaches the kidney through the natural urine passage, while the other reaches it through a small opening in the back. These two views work together during a single operation. This combined approach improves visibility, helps surgeons reach difficult stones, and increases the chance of removing all stone fragments safely in one session.

Why Understanding the Procedure Helps Patients and Families

When patients hear that they need surgery for kidney stones, the process can feel confusing or overwhelming. Many people imagine large cuts or long recovery periods. ECIRS is different from what most people picture when they think of surgery. Understanding how it works step by step helps reduce fear and builds trust in the treatment plan.

ECIRS is usually recommended for stones that are large, complex, or difficult to reach. The technique was developed to improve stone clearance while maintaining safety. Knowing how the procedure is performed makes it easier to understand why it is chosen.

Suggested image: Simple illustration showing the kidney and urinary tract.

A Quick Foundation: How the Kidney Is Reached During Stone Surgery

The kidney connects to the bladder through a tube called the ureter. This natural pathway allows doctors to reach the kidney without any cuts using flexible cameras. Another way to reach the kidney is directly through the back by making a small opening in the skin and muscle.

Traditional procedures usually use only one of these routes. ECIRS combines both at the same time. This combination is the key difference and the reason the procedure can be more effective for complex stones.

Suggested image: Diagram showing natural urinary pathway and direct back access.

Step One: Anesthesia and Patient Positioning

ECIRS is performed under general anesthesia. The patient is fully asleep and does not feel pain during the procedure. Careful positioning is important. The patient is placed in a position that allows access to both the urinary passage and the back.

This positioning allows two surgical approaches to work together without needing to reposition the patient during surgery. This saves time and improves coordination.

Suggested image: Operating table positioning illustration.

Step Two: Retrograde Access Through the Natural Urine Passage

The first pathway used in ECIRS is called the retrograde approach. A thin, flexible camera is passed through the urethra into the bladder and then gently guided up the ureter into the kidney.

This camera allows the surgeon to see the inside of the kidney clearly. It helps identify stone location, size, and how stones are spread within the kidney chambers. This internal view is important for planning the next steps.

Suggested image: Illustration showing flexible scope traveling through the urinary tract.

Step Three: Antegrade Access Through a Small Opening in the Back

The second pathway is called the antegrade approach. A small incision is made in the back, usually less than a centimeter. Through this opening, a narrow channel is created directly into the kidney.

Instruments are passed through this channel to break and remove stones. This direct access provides strength and control, especially for large or hard stones that are difficult to manage through flexible scopes alone.

Suggested image: Diagram showing direct kidney access through the back.

Step Four: How the Two Approaches Work Together

This step is what makes ECIRS unique. The retrograde scope inside the kidney and the antegrade instruments through the back are used at the same time. One view guides the other.

For example, the internal scope can help guide where the back access should be placed. Stones that are hard to reach can be nudged into better positions. Areas that would normally be blind spots become visible. This teamwork improves precision and safety.

Suggested image: Split-view illustration showing dual access working together.

Step Five: Breaking the Stones into Smaller Pieces

Once stones are clearly seen, energy sources such as lasers are used to break them into smaller fragments. The choice of tool depends on stone hardness and size.

Breaking stones carefully is important. The goal is to reduce them into pieces that can be safely removed or flushed out without causing damage. The combined views allow better control during this step.

Suggested image: Illustration of laser breaking kidney stones.

Step Six: Removing Stone Fragments Efficiently

After stones are broken, fragments are removed using the most suitable pathway. Larger pieces may be taken out through the direct back access. Smaller fragments can be removed through the natural urinary passage.

This flexibility helps ensure that stone material is cleared thoroughly. Removing fragments efficiently reduces the chance of stones reforming later.

Suggested image: Visual showing stone fragments being removed.

Step Seven: Final Inspection of the Kidney

Before finishing the procedure, the surgical team carefully inspects the kidney using both scopes. This step ensures that no significant stone fragments are left behind.

This final check is one of the reasons ECIRS can achieve high stone-free rates in complex cases. Seeing the kidney from two angles improves confidence that treatment is complete.

Suggested image: Clean kidney illustration after stone removal.

Step Eight: Placement of Temporary Tubes or Stents

In some cases, a temporary tube or internal stent is placed to help urine drain while the kidney heals. This reduces pressure and helps prevent blockage.

These tubes are usually temporary and removed once healing has progressed. Patients are informed about what to expect and when removal will occur.

Suggested image: Simple diagram explaining a ureteral stent.

Immediately After the Procedure

After surgery, patients are monitored as they wake from anesthesia. Some discomfort, fatigue, or blood in the urine is common initially. Pain is usually controlled with medication.

Most patients stay in the hospital for a short period. The length of stay depends on stone complexity, overall health, and recovery progress.

Suggested image: Recovery room illustration.

Why This Step-by-Step Approach Improves Outcomes

Each step in ECIRS is designed to improve visibility, control, and completeness. By combining two routes, surgeons can adapt to challenges that arise during surgery. This adaptability is especially important for complex stones.

Patients often ask why ECIRS is not used for all stones. The answer is that simpler stones do not require this level of complexity. ECIRS is reserved for cases where its advantages truly matter.

Suggested image: Comparison illustration of single versus combined access.

Safety Measures Built into the Procedure

Safety is maintained throughout ECIRS by continuous monitoring, imaging guidance, and careful coordination between surgical approaches. Antibiotics are often used to prevent infection. Bleeding is monitored closely.

When performed by experienced teams, ECIRS has a safety profile similar to other advanced stone surgeries.

Suggested image: Monitoring equipment illustration.

What Patients Often Worry About

Patients frequently ask whether having two access routes means more pain or risk. In reality, recovery depends more on stone burden and surgery duration than on the number of access points.

Clear explanation before surgery helps set realistic expectations and reduces anxiety.

Suggested image: Doctor explaining procedure to patient.

Conclusion

ECIRS is a carefully coordinated procedure that combines two proven pathways to treat complex kidney stones more effectively. Each step, from anesthesia to final inspection, is designed to improve visibility, precision, and stone clearance. Understanding how ECIRS works step by step helps patients and families feel informed and reassured. When used in the right cases and performed by experienced teams, ECIRS offers a thorough and safe approach to managing difficult kidney stones.