Retrograde ureteroscopic intrarenal surgery for large (1.6-3.5 cm) upper ureteric/renal calculus

OBJECTIVE: To assess the feasibility of retrograde ureteroscopic intrarenal surgery (RIRS) as a viable alternate to percutaneous nephrostolithotripsy (PCNL) in treating patients with renal and upper ureteric calculus of 1.6 cm to 3.5 cm stone burden. MATERIALS AND METHODS: From October 2007 to November 2008, a total of 30 cases of upper ureteric and renal stone of 1.6 cm to 3.5 cm (Average size 2.5 cm) stone burden, for which PCNL would be done otherwise, were treated by RIRS with combined flexible and semi rigid ureteroscope and stones fragmented with holmium laser. The patients were discharged after 24 hours of the procedure and allowed to resume normal work after two days. X ray KUB for radio opaque stones and ultrasound for all the cases were done after three weeks and if any residual fragments of any size were present the patient was taken up for re-look flexible ureteroscopy under anesthesia. Stent and residual fragments were removed. If there was no residue the stent was removed under local anesthesia. RESULTS: Complete clearance was considered if there were no fragments on USG screening after three weeks. Twenty six (86.6%) patients out of 30 had complete clearance in the first sitting and 4 (13.3%) patients needed re-look flexible ureteroscopy. The stone free rate in RIRS is 86.6% in the first sitting and 100% at second sitting. CONCLUSION: RIRS is superior in terms of less complication, less morbidity and good stone free rate and has an advantage of one day of hospital stay and resuming duties after two days. RIRS is the best option for managing extracorporeal shockwave lithotripsy failed and post PCNL residual calculus. RIRS is definitely a viable alternate for PCNL for upper tract stones up to 3.5 cm.