• Percutaneous nephrolithotomy PCNL has become the gold standard for the management of large or complex Renal stones. Retrograde intrarenal surgery (RIRS) has been recently introduced as highly effective technique in management of renal stones specially with anomalous kidney and in coagulopathies.
• Nowadays, achieving a high stone free rate with a lower morbidity have led RIRS to become a commonly used and important treatment modality for management of renal stones less than 2 cm.
• Supine Valdivia position has been modified multiple times till we reached more ergonomic Galdakao-modified supine Valdivia (GMSV) position.
• The GMSV position optimally supports ECIRS (Endoscopic Combined IntraRenal Surgery), a novel simultaneous combined antegrade and retrograde approach to the upper urinary tract for the treatment complex urolithiasis.
• Multiple stones in different parts of pelvicalyceal system which are supposed to need multiple punctures to clear all the stones using classical prone PCNL was always a concern for the surgeon due to morbidity and time consumption for multiple tracks.
• ECIRS in GMSV position can be introduced as a new effective, safe and time saving technique to solve this problem specially with associated ureteral stones.