Retrograde Intrarenal Surgery

RIRS (Retrograde Intrarenal Surgery)


Retrograde intrarenal surgery (RIRS) is a newer technique of removal of stones.

Retrograde intrarenal surgery (RIRS) is a procedure to removal stone from kidney by using a fiberoptic endoscope.

RIRS Surgery allows the surgeon to perform surgery inside the kidney without making an incision.

The RIRS can be effective for difficult-to-treat cases, like Tumors, Patients with bleeding disorders and Stones in children.

Reason for RIRS


  • Stones too large for ESWL (lithotripsy).
  • Patients with gross obesity.
  • Strictures or Tumors.
  • Stones in children.
  • Patients with bleeding disorders.

Procedure of RIRS


RIRS is performed by a specialist, urologist with special expertise in RIRS. The procedure is usually done under general or spinal anesthesia.

Ureteric access sheath is placed on guidewire under continuous fluoroscopy.

Flexible Ureteroscope scope is placed through the urethra (the urinary opening) into the bladder and then through the ureter into the kidney.

The stone is seen through the Ureteroscope and can then be manipulated or crushed by an ultrasound probe or evaporated by a laser probe.

Small stones are grabbed by Urology baskets (Nitinol Baskets). After the RIRS Procedure Double J stent is placed for smooth drainage from kidney and avoid blocking in ureter.

Post Operative Care


The patient will be advised to drink a lot of water so that a urine output of 2.5 liters/day can be maintained and infections can be avoided.

If the patient is feeling well there is no need to take rest.

Advantages of RIRS Procedure


  • No skin incision is required.
  • Stone clearance rates are very high.
  • Safe removal of Kidney stone.
  • Low-risk procedure.
  • Lower operating time.
  • No damage to renal tissue.
  • Fast Recovery.
  • Minimum hospitalization.

Percutaneous Nephrolithotomy

PCNL (Percutaneous Nephrolithotomy)


Percutaneous nephrolithotomy (PCNL) is a surgical procedure to remove stones from the kidney by a small puncture through the skin.

Percutaneous means ‘through the skin’ and nephrolithotomy means ‘taking stones out of the kidney’.

Percutaneous nephrolithotomy (PCNL) is most suitable to remove stones of more than 2 cm in size and which are present near the pelvic region.

PCNL Procedure


Percutaneous stone surgery is usually used for larger stones. It is usually done under general anesthesia or spinal anesthesia.

After contrast medium imaging of the kidney tract on the effected side, the kidney is punctured directly through the skin in the area of the flank. The puncture is controlled via fluoroscopy and ultrasound.

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).

The surgery is performed by Urologist by making a small 1 cm incision in the patient’s flank are. A tube is placed through the incision into the kidney under x-ray guidance. Nephroscope is then passed through the tube in order to visualize the stone, break it up and remove it from the body. If necessary a lithotripter may be used to break up the stone before it can be removed.

The operation usually takes from 90 minutes to two hours.

Aftercare


A standard PCNL usually requires hospitalization for five to six days after the procedure.

The catheter usually stays in place for 1-2 days, depending on how quickly it takes the kidney to recover and the urine to become clearer. The nephrostomy tube will drain urine from the kidney that has been operated on, so the kidney is able to recover. This is usually removed 24-48 hours after surgery.

The urologist may order additional imaging studies (reports) to determine whether any fragments of stones are still present. These can be removed with a nephroscope if necessary. The nephrostomy tube is then removed and the incision covered with a bandage.

The patient will be given instructions for changing the bandage at home.

Patient should be able to go back to work three to four weeks after the operation.

Advantages of PCNL Procedure


  • Less post-operative pain.
  • Less blood loss.
  • Fast Recovery.
  • Shorter hospital stay.
  • higher success rate.
  • Any big size stone can be remove.
  • Earlier return to work and daily activities when compared to open stone surgery.

Ureteroscopy

Ureteroscopy (URS)


Ureteroscopy is where a long thin rigid Ureteroscope is introduced into the upper urinary tract via urethra, bladder, and then directly into the ureter.

Ureteroscopy is an examination of the upper urinary tract the treatment of disorders such as kidney stones in Bladder and Ureter. Smaller stones in bladder or lower ureter can be removed through basket or forcep in one piece, while bigger ones are usually broken through Lthotripsy before removal during ureteroscopy.

Therapeutic ureteroscopy is used in varied applications, including in the treatment of stones, urothelial tumors, and stricture disease.

Ureteroscopy is a safe and minimally invasive method of treating stone disease.

Reasons for Ureteroscopy


  • Kidney stone in the Ureter or Bladder
  • Frequent urinary tract infections
  • Hematuria
  • Unusual cells found in a urine sample
  • Urinary blockage caused by an abnormal narrowing of the Ureter
  • Unusual growth, tumor, or cancer in the Ureter

Procedure of Ureteroscopy


As the procedure is performed under general anaesthesia, you should have nothing to eat or drink for 6 hours prior to treatment.

Doctor gently inserts the tip of the Ureteroscope into the urethra and slowly glides it up into the bladder. A sterile liquid water or salt water (saline) flows through the scope to slowly fill the bladder and stretch it so the doctor has a better view of the bladder wall.

Smaller stones can be removed all in one piece by using Forcep or Stone Baskets.

Larger stones may need to be broken by Lithotripter before then it can be removed by Stone Basket or Forcep.

A temporary urinary stent (Double J Stent) placed in ureter for a short period to ensure the kidney drains without risk of blockage.

Advantages of Ureteroscopy


  • No incision.
  • Ureteroscopy can treat stones located at any position in the ureter and kidney.
  • Ureteroscopy allows the treatment of stones that cannot be seen on an x-ray.
  • In certain cases like women who are pregnant, morbidly obese, Patient taiking Blood Thinner can be treated by ureteroscopy.
  • Can be performed as one day surgery.
  • A highly successful technique (over 95%).

Cystoscopy

Cystoscopy


Cystoscopy is a procedure to see the inside of the bladder and urethra using a telescope. Cystoscopy is the use of a scope (cystoscope) to examine the bladder and urethra.

A cystoscopy can be used to investigate and treat symptoms and conditions that affect the bladder and urinary system. Cystoscope is also called as telescope.

Two types of Cystoscope


  • Flexible Cystoscope
  • Rigid Cystoscope

Reasons for Cystoscopy


  • check for abnormalities in the bladder.
  • Diagnose and evaluate urinary tract disorders.
  • Diagnose the cause of repeated bladder infections.
  • Help determine the cause of pain during urination.
  • remove a sample of bladder tissue (Biopsy) for further testing in cases of suspected cancer.
  • urinary blockage caused by prostate enlargementor some other abnormal narrowing of the urinary tract.
  • Bladder stone removal.
  • Remove foreign objects.

Procedure of Cystoscopy


A urologic surgeon, or urologist, performs cystoscopy. The procedure involves looking at the urinary tract from the inside. Abnormalities can be detected in this manner, and surgical procedures can be performed.

A flexible cystoscopy is usually carried out using a local anaesthetic . A rigid cystoscopy is usually carried out under general anaesthetic or spinal anaesthetic (epidural).

The procedure will take about take 5 – 25 minutes. The urethra is cleansed. This is done without needles. The scope is then inserted through the urethra into the bladder.

The procedure is more painful for men than for women due to the length and narrow diameter of the male urethra. Relaxing the pelvic muscles helps make this part of the test easier.

Water or salt water (saline) flows through the cystoscope for clear vision.

Post Procedural Care


Drink 4 – 6 glasses of water per day after your cystoscopy.

Holding a warm, damp washcloth over the urethral opening.

Taking a warm bath to relieve the burning feeling.

Alternate Names


Cystourethroscopy, Endoscopy of the bladder.

Uroflowmetry

Uroflowmetry


Uroflowmetry procedure measure of the quantity of urine excreted in a specified period of time which is also called as Urine flow rate.

Uroflowmetry is a simple, non invasive diagnostic screening procedure used to calculate the amount of urine (volume), flow rate in seconds, and length of time until completion of the void.

Continuous recording of urine flow by means of a device consisting of a cylinder placed on a transducer that weighs the urine entering thecylinder during voiding and plots the flow rate on a time scale.

Common periods of time used include “minute” and “seconds.”

Reason for Uroflowmetry


  • Benign prostatic hyperplasia (BPH).
  • Pain during urination.
  • Slow urination.
  • Urinary incontinence.
  • Neurogenic bladder dysfunction.
  • Other urination difficulties.

Procedure of Uroflowmetry


Uroflowmetry is best done when you have a full bladder. Doctor ask to patient not urinate for 2 hours before the test. Drink extra fluids so you will have plenty of urine for the test. Generally, no prior preparation, such as fasting or sedation, is required.

Patient will urinate in a special urinal or toilet with a machine that has a measuring device.

Patient will be asked to begin urinating after the machine has started. When you finish, the machine will create a report for your health care provider.

Outcome of Uroflowmetry Test


Changes in the urine flow rate can be indicative of

  • Blockages in the urethra.
  • Weak bladder muscles.
  • Kidney, prostate or other renal disorders.

Normal Urine Flow Rates

Age

Min. Voided Volume

Flow Rates

Years

ml/sec

Males

Females

7-Apr

100

10

10

13-Aug

100

12

15

14-45

200

21

18

46-55

200

22

15

56-80

200

9

10

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TURP Surgery

TURP (Trans Urethral Resection of the Prostate)


Transurethral resection of the prostate (TURP) is a urological process operated to treat benign prostatic hyperplasia (BPH). TURP surgery is also known as resectoscope procedure.

During TURP Procedure, an instrument is inserted up the urethra to remove the section of the prostate that’s blocking urine inflow. It’s frequently used to treat prostate blowup ( benign prostate hyperplasia).

Reasons for TURP procedure


  • Problems with starting urination.
  • Having to urinate more frequently at night.
  • Hesitancy.
  • slow or diminished force of stream.
  • Having an urgent need to urinate.
  • Dribbling after you finish urinating.
  • sensation of incomplete emptying.
  • Blood in the urine.

TURP Procedure (TURP Surgery)


A TURP is prosecuted under general or spinal anesthesia, therefore you won’t feel any pain during the procedure.
Resectoscope is passed into the urethra. It cuts out pieces of towel from the prostate that are bulging or blocking the urethra. An electric current is passed to loop and induce heat, and the heated wire is used to cut away the section of prostate.

The doctor will fit a catheter into the bladder to empty urine.
TURP procedure time depending on how much of prostate needs to be removed.

Recovery Period


Patient can leave hospital two to three days after surgery.

Resume most normal activities within one week.

Advantages of TURP Procedure


  • No longer problem of starting urination.
  • stronger force of stream.
  • decreased need to push.
  • More in control of holding your urine in.
  • No need to get up in the night to urinate as much as you used to.
  • Stronger stream of urine.

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Intracorporeal Pneumatic Lithotripsy

About Intracorporeal Pneumatic Lithotripsy


Lithotripsy is a procedure that breaks up stones in the kidney, bladder, or ureter. In Lithotripsy procedure the physical destruction of hardened masses like kidney stones, Bladder Stone and Uteter Stone.

In the cases where the Extracorporeal Lithotripsy proves to be unsuccessful, Intracorporeal Pneumatic Lithotripsy (endoscopic lithotripsy) is the alternative treatment method.

Intra Corporeal Pneumatic Lithotripter coverts Kinetic impact energy to a mechanical strain which is passed through probe to the calculus. Lithotripter Hand Piece converts Kinetic Energy to Mechanical Strain and it is passing through probe. When energy is transmitted from the Lithocast probe to the calculus, the result is disintegration of the calculus.

Formation of the Stone in human body


The hyper concentration of the dissolved chemicals in the urine crystallizes them. Such crystals form up the stones anywhere in the Kidney, Bladder and Ureters. The stones may vary in size, number and consistency according to their chemical compositions.

There are different types of stones such as Calcium Oxalate, Calcium Phosphate, Uric Acid, Struvite, Cystine and Xanthine etc.

Procedure of Intracorporeal Pneumatic Lithotripsy


Intracorporeal Pneumatic Lithotripter is powerful and based on pneumatically driven projectiles that strike a metallic probe placed endoscopically on a calculus. Probe is passing through rigid endoscopic channel and placed on stone.

Stone (Calculus) break by Ballistic energy and convert in to small fragments. Fragments will be collect by endoscopic basket (Stone Basket) or grasper (Forcep).

These devices work best when they are used through a rigid endoscope, and they can be associated with stone migration during treatment.

Advantage of Intracorporeal Pneumatic Lithotripsy


  • Safe and cost effective procedure.
  • Success rates are 73%- 100%.
  • Most effective method for the removal of large calculi.
  • Faster stone removal compare to other stone removal procedure.
  • No heat generation on the tip of the probe so no damage to the mucosa.
  • Tissue remains unchanged.

Intracorporeal Pneumatic Lithotripsy Products


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Advin Intracorporeal Pneumatic Lithotripter – Digital

  • Pneumatic Control Unit 01
  • Hand Piece – 02
  • Probe – 06
  • Foot Switch – 02
  • Oxygen Regulator – 01
  • Mains Cable – 01
  • Air Tubing – 02