9633507632(Plastic Surgery)
9446501369(Urology Dept)
9061055203(Orthopaedics)
9633507632(Dermatology)
9633507632(Plastic Surgery)
9446501369(Urology Dept)
9061055203(Orthopaedics)
9633507632(Dermatology)
RIRS – Retrograde Intra Renal Surgery.
Advancement of technology in flexible telescopes saw the development of very thin flexible long telescopes whose tip could be bend to visualize 90% of the interior of the kidney. These telescopes of about 2.7mm diameter can be passed up the urethra into the bladder and from the bladder, up the ureter and into the kidney. This procedure is called RIRS or Retrograde Intra Renal Surgery.The ureter is a 2.5 to 4 mm diameter tube connecting the kidney to the bladder. The RIRS telescope can thus be passed as a single stage procedure. However, studies have shown that if this is done in 2 stages, the complication rate and stone clearance rates are better. Hence we prefer to place a stent as first stage and do RIRS 2 to 3 weeks later as a second stage procedure.
RIRS versus ESWL
RIRS is the prefered mode of treatment over ESWL for stones over 1 cm size as the stone clearance rate is much better. ESWL produces some contusion to kidney and surrounding organs and is reported to increase marginally the incidence of Diabetes and Hypertension in the long term. Therefore, when more than one session of ESWL is anticipated, RIRS is the preferred method of treatment. However, unlike ESWL which is an outpatient procedure, RIRS requires anaesthesia and therefore hospital admission. It is also more expensive as the instruments and telescopes for RIRS are very delicate and hence not durable.
RIRS versus PCNL
For stones larger than 2.5cm or very hard stones, PCNL may be a better choice when feasible. Direct access into the kidney in PCNL enalbles use of larger telescopes, stronger laser energy and the ability to remove the fragments. The same procedure by RIRS will require multiple sessions. RIRS however has less chance of major complications.
Your consultant will discuss the various procedures with advantages and disadvantages pertaining to your stone problem.
Before Surgery
You will have blood tests, ECG, Chest X ray etc to assess medical fitness for anaesthesia. This will be done by Urologist, Physician and Anaesthesiologist.
Stent Insertion
For reasons explained earlier, we prefer to pre stent 2 to 3 weeks before RIRS though this is not mandatory.
RIRS
You will have laxatives the day before surgery.
Follow Up
Out patient review will be in about a week. You may be asked to take an X-ray on arrival before seeing the doctor to assess how the stone fragments are being passed. Stent is removed after adequate clearance of the stone fragments and is a simple outpatient procedure.