Outcome of retrograde intrarenal surgery in the management of urolithiasis in a tertiary care centre in North India
Keywords:RIRS, Nephrolithiasis, Minimally invasive
Background: Nephrolithiasis is the most common presenting pathology to the urology clinic. Retrograde intrarenal surgery (RIRS) has made the treatment of upper ureteral and renal calculi a relatively atraumatic affair. We undertook a study to analyse the outcomes of RIRS performed at our institute.
Methods: All patients undergoing RIRS at Government Medical College and Associated Hospitals, Jammu from November 2015 to October 2016 were included in the study population and the data prospectively collected. Patients were followed up till 6 months.
Results: 62 patients underwent the procedure during the study period. Majority of the patients were of the younger age group with 56.45% patients being females. 41.9% (n=26) patients had ureteric calculi which were pushed back while 12.9% (n=8) patients had concurrent ureteral and renal calculi. One patient had a malrotated kidney with calculus, which could be cleared. The median stone size was 12 mm (range 7-18 mm). 87% were stone free at the end of the procedure. 6% procedures had to be abandoned, and 6% patients underwent follow on extracorporeal shock wave lithotripsy (ESWL). The overall stone free rate was 93.54%. The mean post-operative pain score was 2.8. Five patients developed post-operative pyelonephritis and none developed ureteric injury, avulsion or collection. At 6 months, no patient had stone recurrence or hydronephrosis.
Conclusions: RIRS is a relatively safe procedure with good stone clearance. Minimal post-operative pain, with >90% stone clearance make it the cornerstone in the management of renal calculi. Our study shows that RIRS can be safely performed with minimal long term complications.
Kshetrimayum BS, Saitluangpuii S Understanding epidemiology and etiologic factors of urolithiasis: an overview. Science Vision. 2013;13(4).
Scales CD, Smith AC, Hanley JM, Saigal CS. Prevalence of kidney stones in the United States.
Eur Urol. 2012;62(1):160-5.
Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003;63(5):1817-23.
Trinchieri A CG KS, Jun Wu K. Epidemiology. Stone Disease. 2003;13-30.
Ahmet T, Fatin C. The History of Urinary Stones: In Parallel with Civilization. Scientific World J. 2013;423964.
Conlin MJ, Marberger M, Bagley DH. Ureteroscopy. Development and instrumentation. Urol Clin North Am. 1997;24:25-42.
Young HH, Mckay RW. Congenital valvular obstruction of the prostatic urethra. Surg Gynecol Obstet. 1929;48:509-35.
Goodman TM. Ureteroscopy with pediatric cystoscope in adults. Urology. 1977;9:394.
Marshall VF. Fiberoptics in urology. J Urol. 1964;91:110-4.
Kavoussi L, Clayman RV, Basler J. Flexible actively deflectable fiberoptic ureteronephroscopy. Urology. 1989;142:949-54.
Grasso M, Bagley D. A 7.5/8.2 F actively deflectable, flexible ureteroscope: A new device for both diagnostic and therapeutic upper urinary tract endoscopy Urology. 1994;43:435-41.
Zilberman DE, Lipkin ME, Ferrandino MN, Simmons WN, Mancini JG, Raymundo ME. The digital flexible ureteroscope: In vitro assessment of optical characteristics. J Endourol. 2011;25:519-22.
Haberman K, Ortiz-Alvarado O, Chotikawanich E, Monga M. A dual-channel flexible ureteroscope: Evaluation of deflection, flow, illumination, and optics. J Endourol. 2011;25:1411-4.
Hemal AK, Kumar R. Retrograde intrarenal surgery. Indian J Urol. 2000;16:83-7.
Stav K, Cooper A, Zisman A, Leibovici D, Lindner A, Siegel YI. Retrograde intrarenal lithotripsy outcome after failure of shock wave lithotripsy. J Urol. 2003;170(6):2198-201.
Alkan E, Arpali E, Ozkanli AO, Basar MM, Acar O, Balbay MD. RIRS is equally efficient in patients with different BMI scores. Urolithiasis. 2015;43(3):243-8.
Francesco B, Silvia P, Luca C, Fabrizio P, Roberto P, Hennessey D, Orietta D, Luigi S, Guido G . A prospective multicenter European study on flexible ureterorenoscopy for the management of renal stone. Int Braz J Urol. 2016;42(3):479-86.
Babak J, Amir HK, Mohammad MM, Anahita AJ, Saeed A. Retrograde Intrarenal Surgery Versus Shock Wave Lithotripsy for Renal Stones Smaller Than 2 cm: A Randomized Clinical Trial. Urol J. 2016;13(5):2823-8.