Flexible Ureterorenoscopy
Retrograde Intrarenal Surgery
Flexible Ureterorenoscopy (F-URS) is a flexible, thin, bendable endoscopic instrument used to break stones in the kidney and upper urinary canals called Retrograde Intrarenal Surgery (RIRs).
What is RIRs Surgery?
It is the laser fracture of the stones in all chambers of the kidney and the stones located in the upper part of the urinary tract carrying urine from the kidney to the bladder by reaching the stones located in the kidney with a flexible F-URS device.
How is RIRs Surgery Performed?
It is applied under general anesthesia. After entering the kidney with the F-URS device, the stone is broken with various crushing techniques using laser energy. Depending on the size of the patient’s stone and its location in the kidney, the stones are turned into powder-sand or broken into small pieces with laser energy. At the end of the procedure, a catheter and bladder catheter called D-j stand are inserted into the kidney.
Who are the Patients Suitable for RIRs Surgery?
It is especially preferred in the surgical treatment of stones up to 2 cm in the kidney and 1 cm in the proximal-upper ureter. Today, it is applied in larger stones in parallel with the increasing experience and developments in laser devices. It is also preferred in patients who persist in stone after stone crushing treatment, which we call ESWL. Another advantage is that it allows easier access to the kidney in anomalous horseshoe, pelvic and ectopic kidneys.
What is the Hospitalization and Process After RIRs Surgery?
On the day of surgery, patients sleep overnight in the hospital. During hospitalization, they are followed up with a catheter to be removed the next morning. 4 hours after leaving the surgery, the patient can eat. Walking is done in the room and in the corridor on the evening of surgery. The patient is discharged after urinating after the follow-up catheter is removed until noon the next day.
What are the Main Advantages and Disadvantages of RIRs Surgery?
Completely closed, it is done by entering through the outer urinary tract hole. Patients return to their daily activities quickly. It can be used in patients using blood thinners. It also allows laser ablation (burning) of small tumors located in the kidney chambers and urinary tract. The disadvantages are that if the urinary canal is narrow, the canal is expanded by attaching a stand to the patient and stone crushing is left to the 2nd Session. Apart from this, the risks that can be seen after each stone surgery are also present in RIRs surgery.
When to Take D-J Stent During RIRs Surgery?
The stent is usually removed between 1-4 weeks, with an average of 3 weeks after surgery. Stent removal can be performed under local anesthesia or mild sedation. Patients are discharged on the same day.
What Should Be Considered Before RIRs Surgery?
Urinalysis and urine culture are definitely requested before the surgery. If there is an active urinary tract infection, the surgery is postponed. Surgery can be performed after the treatment of urinary tract infection.
What Should Be Considered After RIRs Surgery?
Patients should drink plenty of water after surgery. Frequent urination due to the D-J stand, feeling of urine, bleeding in the urine are the conditions that can be seen. Medical treatments other than drinking plenty of water can be given to patients to reduce these symptoms.