EFFICACY AND SAFETY OF RETROGRADE INTRARENAL SURGERY (RIRS) FOR RENAL STONE CLEARANCE: A PROSPECTIVE INTERVENTIONAL STUDY.

Authors

  • Nikhil Ranjan  Assistant Professor, Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
  • Kumar Dheeraj  Senior Resident, Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
  • Rakesh Kumar Senior Resident, Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
  • Gaurav Babelay Senior Resident, Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

DOI:

https://doi.org/10.51168/sjhrafrica.v5i12.1460

Keywords:

Retrograde Intrarenal Surgery (RIRS), Renal Stones, Stone Clearance, Holmium Laser

Abstract

Background

The management of kidney stones has advanced with the development of minimally invasive techniques like Retrograde Intrarenal Surgery (RIRS). RIRS, which employs flexible ureterorenoscopy and laser lithotripsy, is a highly promising and safe method for the removal of stones, even in complicated cases. Recent technological improvements have expanded its use, particularly for larger stones (> 2 cm), which were previously treated through percutaneous nephrolithotomy.

 Aims

This study seeks to assess the safety and efficacy of RIRS for renal stone clearance in adults. Key objectives include evaluating the success rate of stone removal and analyzing perioperative factors such as surgical duration, complications, and recovery.

 Methods

Conducted at IGIMS, Patna, this interventional investigation was performed on 20 adult patients with kidney stones over one year. The surgery utilized a Holmium laser for stone fragmentation, with post-procedural evaluation through X-ray imaging. Data on stone clearance rates, procedure time, complications, and recovery were collated to examine the procedure’s safety as well as effectiveness.

 Results

The study included 20 patients with a greater proportion of males and a mean age of 33.4 ± 10.6 years. The stones were mainly located in the middle calyx (40%) and lower calyx (20%), with an average size of 1.06 ± 0.36 cm. RIRS achieved a 100% stone-free rate, with an average surgical duration of 90 ± 18.7 minutes and an average duration of hospitalization (approx. 4.6 days). Complications were minimal, with 90% classified as Grade I and 10% as Grade II. A second RIRS session was required in 10% of cases, and 20% of patients needed a postoperative blood transfusion.

 Conclusion

RIRS proved to be a promising treatment for renal stones, demonstrating high stone clearance rates with minimal complications. This technique offers a dependable alternative to traditional treatments, providing shorter hospital stays and manageable recovery outcomes.

References

Tzelves, L., Geraghty, R. M., Hughes, T., Juliebø-Jones, P., & Somani, B. K. (2023). Innovations in Kidney Stone Removal. Research and reports in urology, 15, 131–139. https://doi.org/10.2147/RRU.S386844

Bhanot, R., Jones, P., & Somani, B. (2021). Minimally Invasive Surgery for the Treatment of Ureteric Stones - State-of-the-Art Review. Research and reports in urology, 13, 227–236. https://doi.org/10.2147/RRU.S311010

Setthawong, V., Srisubat, A., Potisat, S., Lojanapiwat, B., & Pattanittum, P. (2023). Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. The Cochrane database of systematic reviews, 8(8), CD007044. https://doi.org/10.1002/14651858.CD007044.pub4

Soderberg, L., Ergun, O., Ding, M., Parker, R., Borofsky, M. S., Pais, V., & Dahm, P. (2023). Percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of renal stones in adults. The Cochrane database of systematic reviews, 11(11), CD013445. https://doi.org/10.1002/14651858.CD013445.pub2

Soderberg, L., Ergun, O., Ding, M., Parker, R., Borofsky, M., Pais, V., & Dahm, P. (2024). Percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones: a Cochrane Review. BJU International, 133(2), 132–140. https://doi.org/10.1111/bju.16220

Aghamir S. M. K. (2021). Successful retrograde intrarenal surgery (RIRS) for a 2-centimeter stone in a chronic renal failure (CRF) patient. International Journal of Surgery Case Reports, 87, 106375. https://doi.org/10.1016/j.ijscr.2021.106375

Van Cleynenbreugel, B., Kılıç, Ö., & Akand, M. (2017). Retrograde intrarenal surgery for renal stones - Part 1. Turkish journal of urology, 43(2), 112–121. https://doi.org/10.5152/tud.2017.03708

Berrettini, A., Boeri, L., Montanari, E., Mogiatti, M., Acquati, P., De Lorenzis, E., Gallioli, A., De Marco, E. A., Minoli, D. G., & Manzoni, G. (2018). Retrograde intrarenal surgery using ureteral access sheaths is a safe and effective treatment for renal stones in children weighing <20 kg. Journal of pediatric urology, 14(1), 59.e1–59.e6. https://doi.org/10.1016/j.jpurol.2017.09.011

Thangavelu, M., Sawant, A., Sayed, A. A., Pawar, P., Hamid, M., Patil, S., Bhise, V., Mathews, J., Shewale, R., & Gadodia, M. (2022). Retrograde Intrarenal Surgery (RIRS) for upper urinary tract stones in children below 12 years of age: A single-center experience. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica, 94(2), 190–194. https://doi.org/10.4081/aiua.2022.2.190

Giulioni, C., Castellani, D., Somani, B.K. et al. The efficacy of retrograde intra-renal surgery (RIRS) for lower pole stones: results from 2946 patients. World J Urol 41, 1407–1413 (2023). https://doi.org/10.1007/s00345-023-04363-6

Inoue, T., Okada, S., Hamamoto, S., & Fujisawa, M. (2021). Retrograde intrarenal surgery: Past, present, and future. Investigative and clinical urology, 62(2), 121–135. https://doi.org/10.4111/icu.20200526

He, M., Dong, Y., Cai, W., Cai, J., Xie, Y., Yu, M., Li, C., & Wen, L. (2024). Recent advances in the treatment of renal stones using flexible ureteroscopies. International journal of surgery (London, England), 110(7), 4320–4328. https://doi.org/10.1097/JS9.0000000000001345

Zeng, G., Zhao, Z., Yang, F., Zhong, W., Wu, W., & Chen, W. (2015). Retrograde intrarenal surgery with combined spinal-epidural vs general anesthesia: a prospective randomized controlled trial. Journal of endourology, 29(4), 401–405. https://doi.org/10.1089/end.2014.0249

Cheng, Y., & Xu, R. (2022). Effectiveness and safety of retrograde intrarenal surgery (RIRS) vs. percutaneous nephrolithotomy (PCNL) in the treatment of isolated kidney stones. American journal of translational research, 14(3), 1849–1858.

Erkoc, M., & Bozkurt, M. (2021). Comparison of Mini-Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for Renal Pelvic Stones of 2-3 cm. Journal of laparoendoscopic & advanced surgical techniques. Part A, 31(6), 605–609. https://doi.org/10.1089/lap.2020.0860

Lim SH, Jeong BC, Seo SI, Jeon SS, Han DH. Treatment outcomes of retrograde intrarenal surgery for renal stones and predictive factors of stone-free. Korean J Urol. 2010;51(11):777–82. doi: 10.4111/kju.2010.51.11.777.

Bozkurt OF, Resorlu B, Yildiz Y, Can CE, Unsal A. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol. 2011;25(7):1131–5. Doi: 10.1089/end.2010.0737.

Perlmutter AE, Talug C, Tarry WF, Zaslau S, Mohseni H, Kandzari SJ. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology. 2008;71(2):214–7. doi: 10.1016/j.urology.2007.09.023.

Pearle MS, Lingeman JE, Leveillee R, Kuo R, Preminger GM, Nadler RB, et al. A prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol. 2005;173(6):2005–9. doi: 10.1097/01.ju.0000158458.51706.56.

Zarse CA, McAteer JA, Tann M, Sommer AJ, Kim SC, Paterson RF, et al. Helical computed tomography accurately reports urinary stone composition using attenuation values: in vitro verification using high-resolution micro-computed tomography calibrated to Fourier transform infrared microspectroscopy. Urology. 2004;63(5):828–33. doi: 10.1016/j.urology.2003.11.038.

Zheng C, Xiong B, Wang H, Luo J, Zhang C, Wei W, Wang Y. Retrograde intrarenal surgery versus percutaneous nephrolithotomy for treatment of renal stones >2 cm: a meta-analysis. Urol Int. 2014;93(4):417-24. doi: 10.1159/000363509. Epub 2014 Aug 27. PMID: 25170589.

Karakoç O, Karakeçi A, Ozan T, Fırdolaş F, Tektaş C, Özkarataş ŞE, Orhan İ. Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of renal stones greater than 2 cm. Turk J Urol. 2015 Jun;41(2):73-7. Doi: 10.5152/tud.2015.97957. PMID: 26328205; PMCID: PMC4548665.

Downloads

Published

2024-12-20

How to Cite

Ranjan, N. ., Dheeraj, K. ., Kumar, R. ., & Babelay, G. . (2024). EFFICACY AND SAFETY OF RETROGRADE INTRARENAL SURGERY (RIRS) FOR RENAL STONE CLEARANCE: A PROSPECTIVE INTERVENTIONAL STUDY. Student’s Journal of Health Research Africa, 5(12), 7. https://doi.org/10.51168/sjhrafrica.v5i12.1460

Issue

Section

Section of General Medicine Research