الفهرس 
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Abstract
Percutaneous nephrolithotomy (PCNL) is the standard treatment for patients with complex or large upper urinary tract stones. PCNL was routinely performed in prone position, which can also provide a wide space for instrument manipulation and avoid abdominal visceral in juries as much as possible. However, it has some potential drawbacks, especially in cardiac, obese, and elderly patients. It may also increase the occurrence of anesthesia complications (position related circulatory and ventilator difficulties) and more co mplex for intraoperative reposition. In addition, this position is also unsuitable for numerous patients with skeletal deformity. Endoscopic combined intrarenal surgery (ECIRS) with simultaneous RIRS and PCNL has been proposed as a new procedure to overcom e the disadvantage of RIRS and PCNL monotherapies in the treatment of complex renal stones ECIRS can increase stone free rates in large renal stones within single session. The aim of this work was to compare the efficacy and safety of ECIRS in the Galdaka o modified supine Valdivia position with Conventional percutaneous nephrolithotomy in prone position for treatment of large and/or complex renal stones in prospective randomized controlled trial This Prospective randomized study was done on 6 0 patients ad mitted to the Urology Department at Tanta University hospital with renal stones planned for PCNL operation during the period from May 20 21 till May 202 3 Patients in our trial were randomly allocated to receive either Conventional PCNL or ECIRS with alloca tion ratio 1:1. Patients with renal stones more than 2 cm were included in the current study and were divided stones more than 2 cm were included in the current study and were divided into two equal groups: group into two equal groups: group AA: included : included 3030 patients subjected to PCNL in patients subjected to PCNL in the prone position. group the prone position. group BB: included : included 3030 patients subjected to patients subjected to ECIRSECIRS in the in the GMSV positionGMSV position. Patients with uncorrectable coagulopathy and active UTI . Patients with uncorrectable coagulopathy and active UTI were excluded from our study.were excluded from our study. Results of the current study could be summarized as Results of the current study could be summarized as followsfollows: The : The mean age of the studied patients was mean age of the studied patients was 52.9 ± 13.9552.9 ± 13.95 years in group years in group AA and and 54.1 54.1 ± 9.10± 9.10 years in group years in group BB. Mean BMI was . Mean BMI was 30.0 ± 2.3530.0 ± 2.35 kg/cm2 in group kg/cm2 in group AA 29.8 29.8 ± ± 2.82 2.82 kgkg/cm2 in group /cm2 in group BB. There was. There was nono statistically insignificant difference statistically insignificant difference between between both groupsboth groups regarding age, body mass indexregarding age, body mass index and and sexsex.. The mean stone size was The mean stone size was 47.7 ± 7.7447.7 ± 7.74mm in group mm in group AA and and 45.9 ± 45.9 ± 8.018.01mm in group mm in group BB and the mean stone density which and the mean stone density which was measuredwas measured by by hounsfield unit was hounsfield unit was 875875..88 ± 2± 26565..3636 in group in group AA and and 951951..44 ± 2± 2886.6.7171 in group in group BB.. As As regardsregards thethe initial initial stone free rate, stone free rate, inin group Agroup A,, 66.7%66.7% of casesof cases wwere ere stone free while in group Bstone free while in group B,, 73.3% were stone free. (p =0.573)73.3% were stone free. (p =0.573).. As As regardsregards auxiliaryauxiliary proceduresprocedures,, inin group Agroup A,, 10 patients required auxiliary procedures10 patients required auxiliary procedures while iwhile in group Bn group B, 8 patients required auxiliary procedures, 8 patients required auxiliary procedures.. After the end of 3 After the end of 3 months follow up and auxiliary procedures the final stmonths follow up and auxiliary procedures the final stonone free rate was e free rate was 83.3% in group A, and 90.0% in group B83.3% in group A, and 90.0% in group B. (p. (p =0.706).=0.706). The operative time The operative time was shorter in ECIRS groupwas shorter in ECIRS group ((112020..55 ± ± 1188.1.166minutesminutes) than in Con) than in Con PCNL group (PCNL group (114949.7.7 ±± 116.6.5050minutesminutes)) with a with a statistically significant difference (p <statistically significant difference (p <0.0010.001)).. PostoperativePostoperative hemoghemoglobin DROP lobin DROP was higher in group Awas higher in group A (mean(mean of 2.0 ± 0.82) than in group Bof 2.0 ± 0.82) than in group B (mean of 1.3 ± (mean of 1.3 ± 0.89) with statistically significant difference between both groups. 0.89) with statistically significant difference between both groups. (p(p<0.001).<0.001).