Retrograde intrarenal surgery (rirs)

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Technological progress has evolved retrograde intrarenal surgery (RIRS) into a safe and efficacious modality for the treatment of the upper urinary tract and has expanded its potential indications to intrarenal large stones (>25 mm), shock wave lithotripsy (SWL) failure, infundibular stenosis, morbid obesity, renoureteral malformations, musculoskeletal deformities, and bleeding diathesis. The development of flexible ureteroscopes and accessory instrumentation like guidewires, ureteral access sheaths, intracorporeal lithotriptors, and stone retrieval baskets has facilitated RIRS and has given more safety to the procedure. Although neither European Association of Urology (EAU) nor American Urological Association (AUA) guidelines recommend RIRS as first-line treatment for intrarenal stones, RIRS has, however, progressed to be a real alternative to shock wave lithotripsy and percutaneous nephrolithotomy (PCNL) for treating renal calculi—offering the low morbidity of SWL combined with stone-free rates comparable with PCNL for small- to moderate-sized renal calculi. Safety and efficacy of RIRS has also been confirmed in children. Thus, RIRS potentially may become first-line treatment for intrarenal stones. We give a description of the technical aspects and the latest developments of flexible ureteroscopes and accessory instrumentation for RIRS. Potential indications of RIRS, the procedure itself, and its complications are described and were reviewed with the current literature.




Gross, A. J., & Netsch, C. (2012). Retrograde intrarenal surgery (rirs). In Urolithiasis: Basic Science and Clinical Practice (pp. 411–416). Springer-Verlag London Ltd.

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