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RETROGRADE INTRARENAL SURGERY & LASER LITHOTRIPSY FOR KIDNEY STONES

Retrograde Intrarenal Surgery (RIRS) : This procedure refers to surgery done inside the kidney with a viewing tube, better known as a fiber optic endoscope. Due to recent technological strides in this field, it has become possible to implement Retrograde Intrarenal Surgery (RIRS) to manage kidney stones.

Using Retrograde Intrarenal Surgery Technology, this procedure can also be performed to remove kidney stones, which can be seen through the endoscope and later crushed or blasted using an ultrasound probe or evaporated using a laser probe or could be manually removed using a pair of small forceps.

 

Who performs this surgery ?

A urologist with specialized expertise in RIRS is best suited to performing RIRS. Retrograde Intrarenal Surgery procedure is done under local, spinal or general anaesthesia using flexible ureteroscopy and laser. This surgery is performed inside the kidney without making any cuts, something made possible by sending the instrument for this procedure through the urethra and into the kidney.

This outpatient procedure is best done for patients suffering with kidney stones, narrowing of the kidney outlet within and outside of it and kidney tumours. This minimally invasive urology procedure is generally used for cases that are otherwise difficult to treat, such as :

  • Failed attempts at treatment
  • Kidney stones too large for treatment by lithotripsy
  • Strictures in the kidney
  • Tumours in the kidney
  • Kidney stones among children
  • Bleeding disorders in the kidneys
  • Grossly obese patients
 

How the surgery is performed :

Before procedure : Pre operative checkups to ascertain the position of the stone the general health condition of the patient and his response to anaesthesia will be conducted one or two weeks before the admission for retrograde intrarenal surgery will be done on the previous day of the surgery. Pre operative Dj stenting will be done 2 weeks prior to RIRS surgery. This procedure is generally carried out under general anaesthesia. On the day of the surgery the patient expected to fast for 4-6 hours.

Surgery : Retrograde Intrarenal Surgery techniques are absolutely remarkable. It is performed by a urologist by passing the endoscope through the urethra into the bladder and through the urethra into that part of the kidney where urine is collected. The scope thus is removed at the upward end of the urinary tract system and within the kidney or intra-renal.

This is a novel technique to remove kidney stones. The ureteroscope can easily remove kidney stones of a maximum of 1.5cm in size. When passed into the kidney through the bladder, the kidney stones are identified and blasted using laser. For the urteroscope to enter the kidneys easily, the ureteroscopy is first dilated by placing a Dj stent in the affected kidney two weeks before the surgery is performed. This leads to quicker recovery of the patient and he or she can resume their daily lives from the third day after surgery.

Post-surgery : After completing RIRS, the patient will be taken to the recovery room where he will receive intensive care. A urine catheter will be fitted into the urethra for a day for minimizing the pain and difficulty while urinating.

The patient will be advised bed rest 24 hours after receiving spinal anaesthesia and to drink plenty of water so that 2.5 liters of urine output per day can be maintained and infections kept at bay. However, if the patient is well enough, he or she need not rest but can be discharged the day after surgery. The doctor can ask to see the patient five days after being discharged from hospital.

Advantages of this procedure : Retrograde Intrarenal Surgery for stone extraction is quicker than traditional open surgery. Besides, patients do not experience pain after surgery and overall, they recover much faster. There is also minimal bleeding and the renal tissue is free of damage. This procedure also produces better clearance of kidney stones.

RIRS is being seen as a safe retrograde endoscopic procedure to treat renal calculi. However, if patients have stones larger than 20mm diameter or several small calculi, especially along with pre-existing tubes or after experiencing urinary tract infections, they belong to a small section of patients at high risk for complications and will not get complete satisfaction from RIRS.

 

An Introduction to Laser Lithotripsy

What is Laser Lithotripsy ?

Laser Lithotripsy for kidney stones refers to a surgical procedure by which stones are removed from the kidney ureter, bladder or urethra. Though kidney stones are a common problem, yet they can be treated and in some cases, prevented too.

If the stone in the kidney is too large to be flushed out of the system naturally or with medication, the specialist may recommend ureteroscopy along with laser lithotripsy. Laser Lithotripsy procedure kidney stones is an outpatient procedure that requires the use of scopes to identify the stone and laser to blast it.

 
How does Laser Lithotripsy work ?

Ureteroscopy refers to the use of a small device known as a ureteroscope that identifies and treats kidney stones. It provides the specialist with a video image of the kidney stone(s) identified and is placed into the bladder and up the ureter till the point that the stone is reached.

The kidney stone can either be broken with laser or pulled out gently with the help of small baskets placed into the working channels. Once the kidney stone is fragmented, it is flushed out naturally through the urinary tract.

Risks of ureteroscopy and laser lithotripsy : It's normal for all medical procedures to have risks, and the same is the case with this procedure too. However, here it is rare to have any complications, but if the patient does come to know of them in advance, it helps to treat them early. So far, Lithotripsy Laser Surgery kidney stones has proved to be both safe and effective in getting rid of painful kidney stones.

For small stones in the ureter or kidney, ureteroscopy has proved to be a good option. It has a higher success rate than that of shockwave lithotripsy. However, the downside of ureteroscopy is that the patient experiences a lot of discomfort post-surgery, especially if a stent is used. Its scope is also limited to small or medium-sized stones because of the size of the instrument. In such a scenario, the specialist may opt for a percutaneous approach.

The kind of treatment chosen for kidney stones largely depend on their size and whether or not they lead to pain or are causing an obstruction in the urinary tract. Small stones measuring not more than 4mm can easily lodge in the kidney for months or years and cause no pain or damage. Usually, kidney stones of this size are flushed out of the system naturally.

At this size, your doctor may decide not to treat them but wait for them to grow a little larger as they could then move into the ureter and block the urine flow and cause the patient severe pain. Some stones larger than 4 mm can be got rid of without surgery by using a recently developed minimally invasive treatment.

On the other hand, there are very large kidney stones, better known as Staghorn stones, that are as painless as they are dangerous because they can silently cause renal failure.

How a urologist does open surgery : Ureteroscopy is usually an outpatient procedure. The urologist begins open surgery by first inserting a scope into the urinary tract to locate the stone. He may either use a cystoscope, ureteroscope, renoscope or nephroscope. He will then insert an optical fiber into the scope's working channel and direct light from the laser onto the stone. The kidney stone is then fragmented and the shards are flushed out of the urinary tract.

Ureteroscopy isn't performed in the upper urinary tract but also inside the kidneys. Just like ureteral stones, kidney stones too can be blasted and removed with the help of baskets. There are times, however, when a kidney stone will form shards that are far too small to be broken. In such cases, the urologist will leave a stent and let the tiny granular bits clear naturally.

Also, if the ureter is too small to send the ureteroscope into the kidney, the urologist will place a stent there and let the ureter expand around the stent. Meanwhile, he will fix the date for the open surgery for 14 days hence. Ordinarily, patients might stay overnight at the hospital if the procedure is difficult or long.

Complications of the surgery : Ureteroscopy with laser lithotripsy is not just a safe surgery but also extremely effective. Though risks and complications are rare, still they are not unknown.

Risks could include those related to general anaesthesia such as vomiting, nausea, chipped teeth, urinary retention, cut lips, headache and sore throat. Before the surgery, the anaesthesiologist will discuss the possible risks patients may encounter and ask if he or she is allergic to particular medication. Other risks include blood clots in the legs that could surface due to pain and swelling. Blood clots can be prevented from forming if the patient gets out of bed soon after the procedure. Shortness of breath can also surface unexpectedly. In such circumstances, the patient should inform the doctor about any such symptoms.

Post-procedure : Laser Lithotripsy post-surgery, the patient is asked to stay in the recovery room until he or she recovers from the general anaesthesia. Ureteroscopy with laser lithotripsy is usually an outpatient procedure which means the patient goes home same day. Being under anaesthesia means that someone else will have to drive the patient home. As the patient recovers, he will feel better. Despite this, it is advisable for him to remain for a day in hospital after the surgery. Usually, people resume their daily routine a day or two after the surgery.

 
Post-procedural care at home :
  • The patient must drink plenty of water, sometimes about 14 cups per day.
  • Salt intake and animal protein should be minimized.
  • Physical activities like walking should be encouraged.

Medication : The urologist may prescribe medication depending on the kind of kidney stone the patient has, so it would help that the patient retains a small sample of it to show the doctor.

Advantage of this surgery : Laser Lithotripsy advantages include the fact that this surgery is a boon because the body's natural openings are used, so no incisions are required to be made.

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