Retrograde Intrarenal Surgery in Delhi

Indications

RIRS is typically indicated for:

• Small to medium-sized kidney stones (up to 2 cm).
• Stones in locations that are difficult to reach with other techniques.
• Patients with contraindications for percutaneous nephrolithotomy (PCNL) or extracorporeal shock wave lithotripsy (ESWL).
• Residual stones after ESWL or PCNL.
• Stones in patients with certain anatomical abnormalities.

Preoperative Preparation

• Evaluation: Imaging studies such as CT scans, ultrasound, or intravenous pyelogram to assess the size, location, and number of stones.
• Lab Tests: Blood and urine tests to check for infection and kidney function.
• Antibiotics: Prophylactic antibiotics to prevent infection.

Procedure Steps

1. Anesthesia: The patient is placed under general or regional anesthesia.
2. Positioning: The patient is positioned in the lithotomy position (lying on the back with legs raised and supported in stirrups).
3. Ureteral Access:
   • A guide wire is inserted through the urethra, bladder, and up the ureter to the kidney.
   • A ureteral access sheath may be placed to facilitate repeated entry of the ureteroscope and to protect the ureter.
4. Ureteroscope Insertion: A flexible ureteroscope is inserted through the urethra, bladder, and ureter into the kidney.
5. Stone Localization and Fragmentation:
   • The stones are visualized using the ureteroscope.
   • Fragmentation is done using laser lithotripsy (commonly Holmium

laser) or other energy sources.

1. • Stone fragments are removed using baskets or graspers.
2. Final Inspection: The kidney is inspected to ensure all stones are removed or adequately fragmented.
3. Stent Placement:
   • A ureteral stent (double J stent) may be placed to ensure drainage of urine from the kidney and to allow the ureter to heal.
   • The stent is usually removed a few days to a few weeks after the procedure.

Postoperative Care

• Recovery: Most patients can go home the same day or after a short hospital stay.
• Pain Management: Pain relief is provided as needed.
• Hydration: Patients are encouraged to drink plenty of fluids to help flush out any remaining stone fragments.
• Activity Restrictions: Patients may be advised to avoid strenuous activities for a few days.

Complications

While RIRS is generally safe, potential complications include:

• Infection.
• Bleeding.
• Injury to the ureter.
• Residual stone fragments.
• Stent-related discomfort.

Follow-Up

Regular follow-up visits are essential to monitor kidney function, ensure proper healing, and check for any residual or recurrent stones. Follow-up imaging may be performed to confirm stone-free status.

Advantages of RIRS

• Minimally invasive with no incisions.
• Shorter recovery time compared to open surgery or PCNL.
• Effective for treating stones in difficult-to-reach areas within the kidney.
• Suitable for patients with certain anatomical variations.

Conclusion

RIRS is a highly effective and minimally invasive procedure for the treatment of small to medium-sized kidney stones. With careful preoperative assessment, skilled surgical technique, and appropriate postoperative care, patients can achieve excellent outcomes and relief from symptoms associated with kidney stones.