URS : Ureteroscopy
Ureteroscopy (URS) is a form of minimally invasive surgery using a small telescope that is passed through the urethra and into the ureter to remove a stone. Often the stone requires fragmentation with a laser which then allows the smaller fragments to removed with a grasping device. Only about 10-15% or urethral stones require surgical intervention. URS is approximately 95% successful in removing stones in the lower ureter and about 85-90% successful in treating and removing stones in the upper ureter and kidney.
URS is an outpatient procedure meaning that patients generally go home the same day. The procedure is typically done using general anesthesia however sometimes regional anesthesia can be used successfully in select cases. A preoperative antibiotic is usually given to prevent infection. The procedure can vary in length-sometimes as short as 20 minutes for small un-complicated stones, to one (1) or longer for larger, more complicated stones.
RIRS: Retrograde Intrarenal Surgery
Retrograde Intrarenal Surgery (RIRS) : This procedure refers to surgery done inside the kidney with a viewing tube, better known as a fiber optic endoscope. Due to recent technological strides in this field, it has become possible to implement Retrograde Intrarenal Surgery (RIRS) to manage kidney stones. Using Retrograde Intrarenal Surgery Technology, this procedure can also be performed to remove kidney stones, which can be seen through the endoscope and later crushed or blasted using an ultrasound probe or evaporated using a laser probe or could be manually removed using a pair of small forceps
PCNL : Percutaneous Nephrolithotomy
Percutaneous stone surgery is usually used for larger stones. A small hollow tube is placed directly through a patient’s back into the kidney through which larger instruments can then be used to fragment and extract the stone(s). Although this approach typically requires a hospital stay and is more invasive than ureteroscopy or extracorporeal shockwave lithotripsy, it is often the most effective method for treating large stones quickly and completely. For more information on comparing the surgical options for kidney stones, see our comparison chart. Percutaneous stone surgery may also be indicated in certain situations where the ureter below a kidney is obstructed, such as in ureteropelvic junction obstructions, where a ureteroscope cannot be advanced from below.
Mini Perc
Mini Perc' is a recently described technique in which percutaneous renal access and lithotripsy are performed in a single step using a 12 to 16Gr micropuncture needle. 'Mini-microperc' is a further technical modification in which an 8 Fr sheath is used to allow insertion of ultrasonic or pneumatic lithoclast probe with suction. This surgery required only one day hospital stay. Afterthis surgery patient not required tube for drainage.
Micro PCNL
Microperc' is a recently described technique in which percutaneous renal access and lithotripsy are performed in a single step using a 16 G micropuncture needle. 'Mini-microperc' is a further technical modification in which an 8 Fr sheath is used to allow insertion of ultrasonic or pneumatic lithoclast probe with suction. The available evidence indicates that microperc is safe and efficient in the management of small renal calculi in adult and pediatric population. It can also be used for renal calculi in ectopic kidneys and bladder calculi. The high stone clearance rate and lower complication rate associated with microperc make it a viable alternative to retrograde intrarenal surgery.
Technique of microperc
The procedure is usually carried out under general anesthesia. However, it can be performed under regional anesthesia if required. In lithotomy position, a 7 Fr ureteric catheter is placed through the ureter into the renal pelvis under cystoscopic and fluoroscopic guidance. Multiple side holes are made in the distal 5 cm of the ureteric catheter to improve the drainage and prevent clogging by stone fragments and blood clots. The ureteric catheter is fixed to 16 Fr urethral catheter and the patient is turned to prone position. The pelvicalyceal system is gently filled with saline injected retrograde through the ureteric catheter. This creates a mild hydronephrosis, which aids in ultrasound-guided calyceal puncture. The 16 G microperc puncture needle is placed into the puncture guide attachment. The use of this attachment facilitates percutaneous renal access. An ideal puncture would be one that leads straight from the skin puncture site through a papilla and the target calyx into the renal pelvis along the line of the infundibulum. Usually, the stone containing calyx is targeted; if the stone is in the renal pelvis, either middle or lower calyceal puncture is preferred. Once proper puncture is achieved, the stylet is removed and antegrade contrast study is performed. If required, the puncture can be adjusted at this step under fluoroscopic guidance. However, puncture can also be achieved with fluoroscopic guidance, wherein contrast is injected from ureteric catheter and percutaneous renal access achieved.
Lithotripsy
Lithotripsy is a procedure that uses shock waves to break up stones in the kidney and parts of the ureter (tube that carries urine from your kidneys to your bladder). After the procedure, the tiny pieces of stones pass out of your body in your urine.
DescriptionExtracorporeal shock wave lithotripsy (ESWL) is the most common type of lithotripsy. "Extracorporeal" means outside the body.
To get ready for the procedure, you will put on a hospital gown and lie on an exam table on top of a soft, water-filled cushion. You will not get wet.
You will be given medicine for pain or to help you relax before the procedure starts. You will also be given antibiotics.
When you have the procedure, you may be given general anesthesia for the procedure. You will be asleep and pain-free.
High-energy shock waves, also called sound waves, guided by x-ray or ultrasound, will pass through your body until they hit the kidney stones. If you are awake, you may feel a tapping feeling when this starts. The waves break the stones into tiny pieces.
The lithotripsy procedure should take about 45 minutes to 1 hour.
A tube called a stent may be placed through your back or bladder into your kidney. This tube will drain urine from your kidney until all the small pieces of stone pass out of your body. This may be done before or after your lithotripsy treatment.