RIRS: Retrograde Intra-renal Surgery ensures complete clearance of renal stone

In this case stenting and ESWL had left one residual fragment in the renal pelvis.



OUR RIRS URETEROSCOPE
In our hospitals;we routinely prestent the patient during ESWL. The reasons being two; one that stenting facilitates the passage of calculus fragments and at the same time safeguards kidney from any obstructive complications. Secondly in the event if the ESWL fails then RIRS during the stent removal can ensure complete clearance.RIRS in presented patient is comparatively easier task as the ureter is dilated and placement of ureteric access sheath becomes easier task.
Review of literature:
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.
The indications for RIRS include:
· Failed previous treatment attempts of ESWL
· Strictures
· Tumors
· Stones in children
· Patients with bleeding disorders
· Patients with gross obesity/KYPHOSCOLIOSIS etc

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.