Indications for and technique of retrograde intrarenal surgery for renal stones

Abstract

Technologic advances over the past 3 decades have resulted in dramatic changes in the interventional management of kidney stones. Prudent application of minimally invasive surgical treatment modalities allows for the opportunity to achieve high stone-free rates with low morbidity and short recovery. Available modalities for the surgical management of kidney stones, including extracorporeal shock wave lithotripsy (ESWL), percutaneous renal surgery (PRS), and retrograde intrarenal ureterorenoscopic surgery (RIRS), obviate the need for open surgery in the vast majority of kidney stone patients. In this chapter, we review the differential indications when treating renal stones, and we review in detail the indications for and techniques of endoscopic RIRS. We discuss currently available stone fragmentation technology and examine in detail specific stone presentations, including stones of varying sizes located in any anatomic portion of the kidney (renal pelvis, superior versus inferior-pole calyces, calyceal diverticula). We also review the role of endoscopic retrograde surgical treatment for patients with anatomic abnormalities that include: fused/ectopic kidneys, allograft kidneys, prior upper urinary tract reconstruction, and body habitus abnormalities. © 2011 Springer-Verlag London Limited.