Retrograde intrarenal surgery (RIRS) is a minimally invasive procedure used to treat kidney stones and other conditions within the kidney. It involves accessing the kidney through the urethra, bladder, and ureter using a small, flexible scope called a ureteroscope. Here's an overview of RIRS:
Indications for RIRS
Kidney Stones: Especially those located in the renal pelvis or upper calyces of the kidney.
Ureteral Stones: Stones that have migrated into the kidney.
Other Conditions: Such as tumors or strictures within the kidney that require visualization and treatment.
Procedure Overview
1. Preoperative Preparation
Patients may be instructed to fast for a few hours before the procedure.
Preoperative evaluation includes blood tests, urine tests, and imaging studies (such as a CT scan) to locate and assess the size and number of stones.
2. Anesthesia
RIRS is typically performed under general anesthesia to ensure patient comfort and immobility during the procedure.
3. Procedure Steps
Insertion of Ureteroscope: The patient is positioned in a lithotomy position (lying on the back with legs raised and supported). A ureteroscope, a thin and flexible instrument with a camera and light source, is inserted through the urethra into the bladder.
Advancement to Kidney: The ureteroscope is then navigated through the bladder and up the ureter into the kidney.
Stone Identification: Once in the kidney, the ureteroscope is used to locate the stones.
Stone Fragmentation: Laser lithotripsy is commonly used to fragment the stones into smaller pieces. Other devices like pneumatic lithotripters may also be used.
Stone Removal: The fragments are either removed using a small basket inserted through the ureteroscope or left to pass naturally through the urinary tract.
4. Stent Placement
A ureteral stent may be placed to ensure urine flow and reduce the risk of ureteral swelling post-procedure. This stent is usually removed after a few days to weeks.
Advantages of RIRS
Minimally Invasive: No external incisions, resulting in quicker recovery and less pain compared to open surgery.
High Success Rate: Effective in treating stones located in the kidney and upper urinary tract.
Precise Stone Removal: Allows for direct visualization and targeted treatment of stones.
Retrograde intrarenal surgery (RIRS) is a valuable technique in urology for treating kidney stones and other conditions within the kidney. Its precision, effectiveness, and minimal invasiveness make it a preferred option for many patients and urologists alike.
