A 45 year old man presented with a 6 mm residual calculus in the inferior calyx post ESWL therapy.
We prefer to do RIRS in such patients rather than going ahead with the second session of ESWL. In RIRS; a fibre-optic tube is inserted through the urethral meatus into the kidney after passing it through bladder and the ureter. The stone is visualized and is thereafter evaporated by a laser probe. We have a 20 W Holmium LASER(Sphinx). The procedure is usually done under general or spinal anesthesia. Retrograde Intrarenal Surgery (RIRS) allows the surgeon to do surgery inside the kidney without making an incision/ and hole on the body.
In cases like this ; where the patient is prestented the ureter is spacious and allows basketing of relatively bigger stone also through the access sheath.We used nitinol basket rather than Holmium LASER lithotripsy in this patient.
We combine the two modalities of ESWL and RIRS routinely in all patients and give 100% success rate after the procedure for all patients. The combination of these modalities ensure elimination of the need for more invasive procedures like PCNL. This is a special boon for patients having physical deformities like obesity or kyphosis.