Retrograde intrarenal surgery in Nepal: an early experience

With the advancement in technology and miniaturization of instruments, retrograde intrarenal surgery (RIRS) with flexible ureteroscope is gaining popularity. Flexible ureteroscope is introduced into renal collecting system through the urethra. Holmium YAG (Ho-YAG) Laser fiber of different sizes is introduced through the ureteroscope and renal stones are pulverized. Removal of renal stones less than 15 mm in size with RIRS has sharply reduced post operative morbidity. This is a Prospective study comprised of 58 RIRS performed from January 2013 to July 2013. Preoperative investigations like full blood count (FBC), renal function test (RFT), serological investigations, urine culture, intravenous urogram or CT-urogram, chest ray and electrocardiogram were done in all patients. Renal stones less than 15 mm in size were included for RIRS. Intra renal stones were treated with 7.5 Fr flexible ureteroscope (Flex - X2) using Holmium-YAG laser. Mean stone burden in our study was 10.5 +/- 3.3 mm. Out of 32 male patients, 29 (90.6%) required pre-stenting before RIRS and all 58 patients with successful dusting of stones in single sitting were discharged on next day. Retrograde Intrarenal Surgery is advanced and successful technique and a viable alternative to Extracorporeal Shock Wave Lithotripsy (ESWL) and Percutaneous Nephrolithotomy (PCNL) in the treatment of selected intrarenal stones with minimum morbidity.