Retrograde Intrarenal Surgery

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Since the first successful ureteroscopy was performed at the beginning of the last century, the development of urology does not stand still. Having undergone great changes, today we are already dealing with robotic surgery, accurate and effective in solving many medical problems.

The evolution of urological techniques reached its peak with the advent of RIRS surgery - retrograde intrarenal surgery by using a flexible urethroscope & a high-power holmium laser.

Indications for RIRS therapy:

  • Poorly performed extracorporeal shock wave lithotripsy
  • X-ray transparent stones that do not appear on CT
  • Concomitant diseases of the ureter and kidney stones
  • Anatomical problems (e.g. Infundibular stenosis)
  • Nephrocalcinosis
  • Bleeding
  • The need for repeated removal of stones

Things to keep in mind

  • Before the procedure, the doctor directs the patient to a comprehensive diagnosis. Here the doctors evaluate the condition of the internal organs, the degree of development of the disease & the general condition of the patient. Intravenous urography can model the image quite accurately, and in combination with a retrograde pyelogram.
  • Computed tomography is often prescribed as an additional study, however, some types of kidney stones may not be displayed by CT. After obtaining consent to the operation from the patient, the doctor informs him about all stages of treatment and issues related to rehabilitation: what prescriptions must be followed so that recovery takes place as soon as possible, without pain.
  • For surgery, it is not necessary to make massive incisions that can cause bleeding and other complications. The doctor places a flexible fiber-optic ureteroscope into the ureter through the urethra and bladder. The tool is directed to the stone and, depending on the type of stone, removes it. For this purpose, either excision or laser crushing can be used.

The percentage of complete cure after the primary operation is 83%, & after the secondary is 95%.

Patients were tested from three different groups:

  • Stones 10 mm or less
  • Stones 20 mm or less
  • Stones over 20 mm

The overall fragmentation rate (stone fragment <2 mm in size) was 91%. The total rate of stone crushing was 94% and 95% for groups 1 and 2, and 82% after two treatments for group 3. The study showed that the optimal size of kidney stones for performing retrograde intrarenal therapy is no more than 1.7 cm. However, doctors show a high percentage of cures in patients whose stone size exceeds 1.7 cm.


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