Tuesday, 7 February 2017

Ever thought a Kidney Stone can be removed without making even a single cut in the body?

Retrograde Intrarenal Surgery (RIRS)

RIRS is the latest technology in removal and management of kidney stones that extends the frontiers of medical sciences beyond contemplation. Progressive innovations in techniques together with recent advancements in flexible ureteroscopes with the advent of digital technology, refinements of endo-urological devices and advancement in holmium laser technology have been very impressive. Where at one point an open surgery with a very long period of recovery was the only option, research introduced minimally invasive procedures with very fast recovery phase and finally today, we stand at a point where not a single cut in the body is made for treating kidney stones. RIRS becomes a reasonable alternative to percutaneous lithotomy even for stone larger than 2 cms.


Who can perform RIRS?

RIRS is performed by an urologist (endourologist) with specialized expertise in performing this procedure.

How is RIRS performed

Not a single cut in the body is made and the problem is solved!

A spinal or general anaesthesia is administered for ease. The surgeon then inserts a fibre optic endoscope to view the inside of a kidney, going from the urethra (urinary opening) into the bladder and from there into the ureter reaching finally inside the urine collecting part of the kidney.  Once the scope is in place, the surgeon then starts either fragmenting or evaporating the stone using 100-Watt Coherent holmium laser probe. The surgeon may also choose to remove the stones manually with small forceps even. When stone fragments appear to be less than 2 mm the procedure is considered terminated and no attempt is made to remove all debris physically however, the larger stone pieces are removed using a litho catch basket. The advantage of Holmium Laser is its ability to fragment stones of all compositions with precision. A stent is then placed if needed, which is removed after a week by flexible cystoscopy. A catheter is left in place for a day after the procedure. Patients are generally admitted on the same day of the treatment and are discharged next day, which means only 24 hours of hospitalization is required.


RIRS Indications:

•    Ureteric or kidney stones
•    Tumours of ureter and kidney
•    Stricture of urinary tract


Advantages of RIRS

•       Can be done in patients of bleeding diathesis and gross obesity
•       Can be done in any age group
•       Less chances of bleeding
•       Less invasive (Low-risk procedure)
•       Stricture and stone can be tackled at same time
•       Stich less and incision less surgery
•       Lesser pain - faster recovery - Minimum hospitalization
•       Stone clearance rates are very high
•       Both ureteric and renal stones can be tackled at same time
•       Small kidney tumors can also be tackled 

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