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 

Read More

Kidney Stones Treatment

Kidneys filter waste from blood and produce urine that is passes out of the body. However, sometime stone forming substances like (salt and minerals) may join together to form small stones which over time build and grow in size to form hard stone-like lump. The situation is more probable in case a person is dehydrated or is consuming less fluids. Certain medications also increase the levels of stone forming substances in the urine therefore it is important to keep the urine diluted and clear. Once a stone is present the body tries to pass it out when you urinate. Very smalls stones painlessly pass through the urine however if a stone is 5mm in size the changes of it passing on its own in the urine come down to 50 per cent. The small stones can be also be very painful sometimes but the pain disappears once the stone passes through the urine. 

What can help in such cases:

Medication

In case the pain is unbearable you might be given an injection for alleviate your pain. You might be administered a second dose again after half an hour depending upon the severity of your pain.

Lifestyle

If you are having a kidney stones then it is important that you drink a lot of water. In case it has passed in the urine you can collect it and send it for analysis. The doctor will check what type of changes you need to make in your diet and medication depending upon the constitution of the stone.

Clinical Procedures to treat Kidney Stone

"The latest treatment in the world to remove Kidney Stones is RIRS where NOT A SINGLE CUT IS MADE IN THE BODY to remove the kidney stones." - Department of Urology, Aastha Kidney Hospital. 

The very large stones (6-7 mm) pose problem as they try to pass through the ureter naturally from the kidney into the bladder causing very severe flank pain that extends to the groin. This is because the tube (ureter) connecting the kidney to the bladder is narrow and a large stone is not able to pass through easily. 

Extracorporeal Shock Wave Lithotripsy (ESWL)

For a Stone 4 mm to 2 cm in size and in the kidney or part of the ureter close to the kidney causing pain or blocking urine flow.  

This procedure takes about an hour. You will be made to lie down comfortably on a water filled cushion. A sedative or a local anesthesia may be administered. Following this an  X-ray or ultrasound test is carried out to locate the exact position of the stone in the body. Extracorporeal shock wave lithotripsy (ESWL) uses high energy sound waves to crack open and disintegrate the stones into smaller fragments. These high energy sound waves pass through the body without injuring it. The smaller fragments pass through the urine.

In case of a large stone a stent may be placed to keep the ureter open so that smaller stone fragments may pass easily without blocking the ureter.  

After the procedure

There is no need to stay in the hospital overnight. In fact you may go home the same day. Small pieces of stone which have disintegrated will pass out through the urine causing mild pain. This may happen for a few days. However, in case of a very large stone  the procedure may have to be repeated again or other treatments carried out.

RISKS

    Pain caused by passage of stone fragments.
    Stone fragments might get stuck in the urinary tract. These will have to be removed with a ureteroscope.
     UTI (Urinary tract infection)
    Bleeding around the outer side of the kidney

Ureteroscopy

If a stone is stuck in the ureter close to the bladder (in the lower third or ureter)

A Thin Tube (Ureteroscope ) is passed from the outside of the body into the urethera, making its way up to the bladder and from there into the ureter (i.e the pipe which carries urine from kidney to the bladder) to the point where the stone is located.  The kidney stone is removed with the forceps. Smaller stones can be removed in one piece but larger stones are broken down into smaller pieces before they are removed, most common technique being laser.  While carrying out ureterocopy no cuts or incisions are made in the body.

After the treatment

Although in most cases a person can go home the same day of the procedure. However, in case there is  a requirement for you to stay in the hospital it will only be for a day or two. After the treatment a person may experience a burning sensation while urinating which goes away in a day.  The burning can be reduced by drinking plenty of water. A doctor may also recommend a painkiller. Some blood may also come in the urine maybe for 2-3 days. 

RISKS

These usually are likely if the stone is close to the upper third of the ureter.
    Bleeding
    UTI (Urinary tract Infection)
    Injury to Ureter
    Abdominal pain

Percutaneous Nephrolithotomy (PCNL) /Nephrolithotripsy

If the Kidney stone is irregular, larger than 2 cm diameter within the kidney 

The operation takes about 20 -45 minutes. During the procedure a general anesthesia is administered the person is made to lie on the stomach.  A keyhole surgery is performed by a 1 cm incision at the back in the skin above the kidney. An X ray image is used as a guide to decide the entry point of 1cm tube into the kidney. Once the surgeon is inside the kidney a nephroscope (minature fibre optic camera) and other instruments are threaded in through the hole that are able to see, fragment and remove stones.  A drainage catheter which leaves through the skin is left in the kidney at the end of the procedure. The whole idea is to remove all the stones leaving no fragments behind that may pass through the ureter. 

After the procedure

A short hospitalization (2-3 days) may be needed. You may be off work for a week taking it easy. There should only be minimal discomfort from the wound. Oral antibiotics are given to prevent further infection. Occasionally a stent is left to ensure that urine drains correctly in the bladder which will be removed later. In case a person is feeling unwell with fever, chills or is having heavy bleeding in the urine is it important to contact your doctor.

Advantages

Most effective procedure that ensure a patient is stone free.

Risks

    Infection
    Bleeding
    Operations on the abdomen carry a small risk of injury to other nearby organs, such as the bowel, the ureter, the liver or the bladder.

Read More