Role of Retrograde Intrarenal Surgery in Management of Renal Stones: 3 Years Experience

Introduction and Objective: Retrograde Intrarenal Surgery (RIRS)is considered as a minimally invasive procedure for management of renal stones with minimal morbidity. Our objective is to demonstrate its effectiveness in management of not just small, but even large, multiple and staghorn stones.

Methods: A prospective study was done of 274 patients who presented to us with renal and upper ureteric stones and were managed with RIRS. Preoperatively, stone size and laterality were assessed on NCCT KUB and X-ray KUB. Intraoperative parameters assessed were operative time, need for ureteric dilatation and intraoperative complications. Post operatively, check X-ray KUB/USG KUB was done before stent removal. Patients were followed up in outpatient department and telephonically.

Results: Out of 274 patients, 185 patients were males and 89 were females. 83 patients had single stone and 191 patients had multiple stones. 25 patients were pre stented in view of septicemia or renal impairment. 47 patients had renal impairment at the time of presentation, which improved in all patients and returned to normal value in 36 patients. 85 patients underwent bilateral RIRS and 189 underwent unilateral RIRS. 68 patients had stone size <1 cm., 99 patients had 1-2 cm. and 107 patients had more than 2 cm sized stones. 6 patients had residual stones out of which, 3 patients underwent URS, 2 patients underwent RIRS and 1 patient underwent ESWL.

Conclusion:RIRS is feasible in large stone burden like partial and complete staghorn stones with minimal morbidity. Our study demonstrates its effectiveness in large stone burden(size>2cm.), with additional procedure required in < 3% patients.