Renal Stone- RIRS & PCNL
Renal stones, or kidney stones, are solid deposits of minerals and salts that form in the kidneys. When these stones require surgical treatment, two common minimally invasive techniques are RIRS (Retrograde Intrarenal Surgery) and PCNL (Percutaneous Nephrolithotomy). Here's an overview of these procedures:
Retrograde Intrarenal Surgery (RIRS)
RIRS is a minimally invasive procedure to remove kidney stones by using a flexible ureteroscope passed through the urethra, bladder, and ureter into the kidney. The stone is fragmented using a laser (Holmium laser) and the fragments are removed.
Indications:
- Stones ≤ 2 cm in size.
- Stones located in difficult-to-reach areas of the kidney (e.g., lower pole).
- Patients with a high risk of complications from open or percutaneous surgery.
- Failed extracorporeal shockwave lithotripsy (ESWL).
Procedure:
- Anesthesia: Typically performed under general or spinal anesthesia.
- A ureteroscope is inserted via the urethra and navigated to the kidney.
- A laser is used to break the stone into small fragments.
- The fragments are removed, or they may pass naturally after the procedure.
- A stent may be placed temporarily to ensure proper drainage.
Advantages:
- No external incisions.
- Short recovery time.
- Less blood loss and minimal post-operative pain.
Disadvantages:
- Not suitable for very large stones.
- Risk of infection or ureteral injury.
- May require multiple sessions for larger stones.
Percutaneous Nephrolithotomy (PCNL)
PCNL is a minimally invasive surgical technique used to remove larger kidney stones through a small incision in the back.
Indications:
- Stones > 2 cm in size.
- Staghorn calculi (branched stones filling the renal pelvis).
- Stones resistant to other treatments like RIRS or ESWL.
- Obstructive or symptomatic stones.
Procedure:
- Anesthesia: Typically performed under general anesthesia.
- A small incision is made in the back to access the kidney.
- A nephroscope is inserted through a tract into the kidney.
- The stone is fragmented using ultrasonic, pneumatic, or laser energy.
- Fragments are removed, and a nephrostomy tube may be left temporarily for drainage.
Advantages:
- Effective for large or complex stones.
- High stone clearance rate in a single session.
- Direct access to the stone.
Disadvantages:
- Requires a small incision.
- Slightly longer recovery time compared to RIRS.
- Risks include bleeding, infection, or injury to surrounding structures.
Comparison of RIRS and PCNL
| Feature | RIRS | PCNL |
|---|---|---|
| Stone Size | ≤ 2 cm | > 2 cm |
| Invasiveness | Non-invasive (no incision) | Minimally invasive (small incision) |
| Recovery Time | Short | Moderate |
| Stone Clearance | May require multiple sessions | High in one session |
| Risks | Ureteral injury, infection | Bleeding, infection, organ injury |
| Hospital Stay | 1 day | 2–3 days |
Choosing Between RIRS and PCNL
The choice depends on factors like:
- Stone size and location.
- Patient’s overall health and comorbidities.
- Surgeon’s expertise.
- Availability of equipment and facilities.
Post-Procedure Care
- Adequate hydration to flush out residual fragments.
- Medications to manage pain and prevent infections.
- Regular follow-ups, including imaging (ultrasound or CT), to check for residual stones.
If you’re considering treatment or want detailed insights into either procedure, consulting a urologist with expertise in stone management is essential.
