Changing Scenario in Kidney Stone Treatment ! -Dr. K M Nanjappa

Dr. K M Nanjappa - Consultant Urologist & Director – Cauvery Uroderm Centre, Kalyan Mumbai

Most of the kidney stones can be managed with medications, but some will require aggressive surgical treatment to prevent complications and Renal failure. In today's era, surgical treatment strategies are minimally invasive like extracorporeal shockwave lithotripsy (SWL),ureteroscopy (URS), percutaneous nephrolithotomy (PNL), and Retrograde intrarenal surgery (RIRS).

Retrograde intrarenal surgery (RIRS) or flexible ureteroscopy is the least invasive procedure for doing surgery within the kidney. It uses a flexible endoscope instead of a rigid scope. In RIRS, the scope is placed through the natural urinary opening called the urethra and into the bladder and then through the ureter into the kidney. The scope thus, is moved retrograde (up the urinary tract system) to within the kidney (intrarenal). The stone can be seen through the scope, on a monitor screen and can be manipulated, then grabbed and retrieved by a basket or can be broken into pieces or completely dusted by Laser, however hard or soft it is. This gives a complete clearance and better results than many of the existing modalities. Patients can go home the same day or the very next day. RIRS should be performed by a specialist, a urologist (endourologist) with special expertise in RIRS.

Though it has a tremendous advantage in treating most of the renal calculi, it is the procedure of choice in calculi in Pregnant patients, Patients with abnormal kidney (malrotated), patients on blood thinners and especially Patients who want a 100 percent stone clearance for employment, like Pilots and offshore workers on rigs. This is possible because RIRS has maximum success with minimal loss of working days. RIRS or flexible ureteroscopy is one of the most preferred techniques to manage kidney stones today. The management of Stone disease (especially RIRS) is a perfect blend of Technology and Technique. There has been a revolution in the technology of RIRS in the last few years and future research is also on. The scope used for the procedure has now changed from fibreoptic to digital, with better vision. The miniaturization of the scopes, (thinner scopes) has made access to the kidneys easier. The new generation of disposable scopes are digital and lighter also, thus are ergonomically friendlier to the surgeon too. There are many advances in Lasers and suction also, so the indications for the procedure is expanding. RIRS is a scarless, sutureless, minimally invasive procedure performed through the natural orifice with the least morbidity. With advances in technology and technique, the future appears bright, as even large volume stones can be treated with RIRS thus replacing other invasive modalities.