Retrograde Intrarenal Surgery- What Is It All About?

If you read a lot on urology and its related aspects, then you may have heard about retrograde intrarenal surgery (RIRS). It is a crucial term and a form of surgery that is delineated in this article. Read on for more information.  

An Introduction  

Urolithiasis or kidney stone disease has increased steadily over the last few years, particularly in developed nations. It may have a connection to aspects like socio-economic fluctuations, lifestyle conditions, diabetes, obesity, metabolic syndrome, and sedentary jobs. The strategies for treating this condition are usually minimally invasive and include RIRS (retrograde intrarenal surgery). Here are some points worth noting about the same:  

RIRS is a procedure which is the least invasive with regard to surgeries within the kidney, using a fiberoptic endoscope or viewing tube.  The scope goes through the urinary opening (urethra) in this treatment and into the bladder before passing into the part of the kidney which collects urine (via the ureter).  The scope is hence moved in retrograde fashion (upwards into the urinary tract) to within the kidney (which is known as the intrarenal procedure).  The scope helps view the stone and it can be crushed or manipulated through the ultrasound probe. A laser probe may also be used to evaporate it or forceps can be used to grab it as well.  RIRS is conducted by urology specialists, urologists (endourologists), and those with expertise in these surgeries.  It is done under spinal or general anesthesia.  

Some More Facts about This Form of Treatment 

Here are a few pointers that should be kept in mind:  

The core aim of RIRS is to clear stones completely with zero morbidity.  RIRS has become safer and more effective with technological advancements like better lithotripters (holmium) and ureterorenoscopes.  Other innovations in guide-wires, stone baskets, and ureteral access sheaths have also made this process more efficient. Most renal stones can be successfully treated nowadays due to these reasons. There is no need for percutaneous nephrolithotomy or open surgery as a result.  RIRS is often used as a primary treatment method for those who have renal stones that are tinier than 2 centimeters, especially in scenarios like bleeding diathesis and obesity.  

Indications 

Lower calyx stones.  Stones tinier than 1.5 centimeters.  Medium-sized stones that are not suitable for other procedures.  Non-opaque stones.  Any anatomic abnormalities like a narrow infundibulum, long lower pole calyx, and acute IPA.  Ureteral and renal stones co-exist.  Those who need fully stone-free treatments.  Bleeding issues.  Multiple kidney stones.  Requirement for the treatment of bilateral renal stones in one session.  Renoureteral malfunctions.  

Treatment Basics 

Preoperative evaluation of patients, informing them about success rates, treatment technique, and potential complications.  Informed consent is a must along with a pre-operative examination comprising routine blood tests, physical examinations, urine culture and tests, kidney-ureter bladder tests, renal ultrasound, x-rays, intravenous urography, and non-contrast computed tomography.  General anesthesia is mostly preferred for RIRS.  The surgical technique makes use of various instruments like the C-arm fluoroscope, flexible ureterorenoscopes, and the semi-rigid ureterorenoscopes. There are also instruments like guide-wires, ureteral access sheath, and irrigation pump among others.  

There is also the postoperative care element, especially if a J-stent has been placed post the operation. It is usually left in situ for a period of 3-10 days on a postoperative basis. In case of any ureteral injury, patients should be stented for 3-6 weeks at least. Postoperative examinations help diagnose any residual stones and also obstructions. Knowing more about the treatment and its basics is essential for those who have kidney stone issues that they wish to treat in the near future.