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Retrograde Intrarenal Surgery (RIRS)

Overview

Retrograde Intrarenal Surgery (RIRS) is a minimally invasive endoscopic procedure used primarily to treat kidney stones. In this technique, a flexible ureteroscope is passed through the urethra, bladder, and ureter to reach the kidney, allowing the surgeon to visualize and treat stones or other issues within the kidney without the need for any external incisions.

RIRS is preferred for patients with stones that are too large for extracorporeal shock wave lithotripsy (ESWL) or stones that cannot be treated by percutaneous nephrolithotomy (PCNL) due to their location or patient-specific factors.

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Dr. Kumar Saurav
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How is Retrograde Intrarenal Surgery (RIRS) Done?

Pre-Procedure Evaluation:
  • History and Physical Examination: A thorough medical history is taken to assess any comorbidities like hypertension, diabetes, or cardiovascular disease that may impact the procedure.
  • Imaging: Preoperative imaging, such as a CT scan or ultrasound, helps in assessing the size, location, and number of stones.
  • Lab Tests: Blood and urine tests are done to evaluate kidney function, detect infection, and check clotting profiles.
  • Antibiotics: If there is a urinary tract infection (UTI), antibiotics may be administered before the procedure.
Medications:
  • Patients may need to stop certain medications like blood thinners (e.g., aspirin or warfarin) before the procedure.
  • Appropriate pain medications may be prescribed in advance.
Fasting:
  • Patients are typically instructed to fast for 6-8 hours before the procedure due to the anesthesia requirements.
Hydration:
  • IV fluids may be administered to ensure adequate hydration and help flush out any residual stone fragments post-procedure.

Anesthesia:
  • General or spinal anesthesia is typically used, ensuring the patient remains pain-free during the procedure.
Access to the Kidney:
  • A flexible ureteroscope is passed through the natural urinary tract (urethra, bladder, ureter) into the kidney.
Stone Visualization and Treatment:
  • Once the ureteroscope reaches the kidney, the surgeon identifies the stones.
  • A laser (Holmium laser is commonly used) is employed to fragment the stones into smaller pieces.
Stone Removal:
  • The fragments may either be left to pass naturally or be extracted using specialized baskets inserted through the ureteroscope.
Stent Placement:
  • A ureteral stent (a thin tube) is sometimes placed in the ureter to help maintain urine flow and promote healing, especially if there is swelling or the patient has multiple stones.
Duration:
  • The procedure typically takes between 45 minutes to 2 hours, depending on the size, number, and location of the stones.

Although RIRS is generally considered safe, complications may arise, including:

  • Infection: Post-procedural infection, such as a urinary tract infection (UTI) or sepsis, may occur.
  • Bleeding: There may be minor bleeding during or after the procedure.
  • Injury to the Urinary Tract: There is a risk of injury to the ureter, bladder, or kidney during the procedure.
  • Ureteral Stricture: The ureter may become narrowed or scarred following the procedure, causing obstruction.
  • Stone Recurrence: There is a possibility of stone recurrence over time.
  • Stent-Related Discomfort: If a stent is placed, patients may experience discomfort, urgency, or pain during urination until the stent is removed.
Benefits of RIRS
  • Minimally Invasive: RIRS is performed without external incisions, reducing recovery time and the risk of complications.
  • Targeted Treatment: Allows for direct visualization and treatment of stones, including those in difficult-to-reach locations.
  • High Success Rate: Particularly effective for stones up to 2 cm in size and those that are resistant to other treatments.
  • Reduced Pain: Compared to open or percutaneous surgery, RIRS results in less postoperative pain and discomfort.
  • Short Hospital Stay: Most patients can go home the same day or after a short hospital stay.

Infrastructure and Facilities for RIRS

To perform RIRS successfully, the following infrastructure is essential:

  • Operating Theater: A sterile environment with modern equipment, including high-definition endoscopic systems and laser technology (e.g., Holmium laser).
  • Imaging Systems: High-quality preoperative imaging (e.g., CT or ultrasound) and intraoperative fluoroscopy systems to guide the procedure.
  • Ureteroscopes and Accessories: Flexible ureteroscopes, stone extraction baskets, and stents.
  • Anesthesia and Monitoring Systems: Facilities for administering general or spinal anesthesia, along with monitoring of vital signs.
  • Post-Operative Care Facilities: Recovery areas equipped for monitoring patients post-procedure, with access to IV fluids and medications.
  • Laboratory Services: On-site labs for blood and urine tests to assess kidney function, infection, and coagulation profiles.

FAQs

RIRS is ideal for patients with kidney stones smaller than 2 cm, stones that are located in difficult-to-access areas of the kidney, or when other treatments like ESWL have failed.

Most patients recover within a week and can resume normal activities. However, if a stent is placed, it may cause some discomfort until it is removed after a few days or weeks.

The procedure itself is not painful due to anesthesia, but some patients may experience mild pain or discomfort after the procedure, particularly if a stent is placed.

Follow-up is usually required to check for any residual stone fragments and to ensure proper healing. Imaging may be repeated, and the stent, if placed, will be removed.

If stones recur, your urologist will assess the underlying causes, such as diet or metabolic disorders, and suggest lifestyle changes, medications, or further treatments.

Your doctor may recommend dietary adjustments, particularly if your kidney stones are linked to specific types of minerals or substances in your diet, like calcium or oxalate. Hydration is key to preventing recurrence.

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Website Design and Development by Sterco Digitex

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