Retrograde intra-renal surgery (RIRS)

Abstract

Retrograde intrarenal surgery (RIRS) has markedly evolved and now plays an important role in the first-line treatment of renal calculi of less than 20 mm. RIRS is a delicate operation that uses a lot of miniaturized instruments including flexible ureterorenoscope (FURS). Understanding characteristics of instruments and surgical techniques is important for safe and effective operation. A variety of FURS is on the market and has various functional distinctions. Image transfer technology, number of working channel, and durability are important issues for proper selection of FURS. There is a learning curve to be familiarized with FURS. Understanding basic principles of FURS manipulation will shorten the learning time and reduce the maintenance cost of FURS. Currently, three stone-breaking methods are widely used. Fragmentation with basketing is optimal in the treatment of small hard stones. Dusting makes large stones to tiny pieces by low pulse power laser. It eliminates the necessity of stone basket use. Stone debris that is not suitable for basketing or dusting can be treated by popcorn method that utilizes whirlpool phenomenon. Various combination of stone breaking/removal strategy may be applied to achieve good surgical outcomes.