Management of Upper Ureteric Calculus with RIRS at Institute of Urology, Jaipur

Management of Upper Ureteric Calculus with RIRS at Institute of Urology, Jaipur: Upper ureteric calculi pose a significant clinical challenge, particularly when associated with ureteral inflammation or obstruction. Retrograde Intrarenal Surgery (RIRS) has emerged as a preferred minimally invasive option for managing such cases. This report presents a case of a 14 mm upper ureteric calculus successfully treated with RIRS, emphasizing the effectiveness of this approach and the patient-centric care model at the Institute of Urology, Jaipur.

Upper ureteric stones larger than 10 mm are typically managed with surgical interventions, as medical expulsive therapy often proves inadequate. RIRS has revolutionized stone management by offering a minimally invasive alternative that avoids incisions and ensures quicker recovery.

The Institute of Urology, Jaipur, under the expert guidance of Dr. M. Roychowdhury and Dr. Rajan Bansal, employs state-of-the-art equipment and techniques adhering to global best practices.

Case Presentation

Clinical Background

A middle to elderly male presented with:

• Right-sided flank pain for weeks.
• No significant past medical history.

Investigations

1. Imaging:
   • Ultrasound (USG): Revealed a 14 mm upper ureteric stone causing mild hydronephrosis.
   • X-ray KUB: Confirmed the stone location and size.
2. Laboratory Tests:
   • Normal renal function.
   • No signs of infection.

Initial Management

• The patient was counseled regarding treatment options, and RIRS was chosen for its minimally invasive nature and high success rate.

Procedure

Operative Details

• Anesthesia: General anesthesia.
• Technique:
  • A flexible ureteroscope was advanced through the natural urinary passage.
  • Holmium laser was used to fragment the 14 mm calculus into smaller pieces, which were then removed using a basket retrieval device.
  • A double-J stent was placed to facilitate ureteral healing due to inflammation caused by the large stone.

Outcome

• The procedure was completed without complications.
• The patient was discharged the next day.

Follow-Up

• The double-J stent was retained for 6 weeks, longer than the standard 2–4 weeks, considering the inflammation in the ureter locally caused by the large stone.
• At 6 weeks, the stent was removed.
• A review X-ray and USG confirmed 100% stone clearance, and the patient was symptom-free.

Discussion

Efficacy of RIRS

RIRS is particularly effective for upper ureteric stones, with reported success rates exceeding 90% for stones <20 mm in size. It offers the following advantages:

• Minimally Invasive: No incisions; stones are accessed through natural pathways.
• Reduced Recovery Time: Shorter hospital stays, typically 24–48 hours.
• Enhanced Patient Comfort: Less postoperative pain and quicker return to daily activities.

Extended Stenting in This Case

The prolonged stenting period facilitated optimal healing of the ureteral lining affected by stone-induced inflammation. Studies have supported extended stenting in cases of severe ureteral injury or inflammation to reduce stricture formation and ensure smooth ureteral function post-procedure【1】【2】.

Institute of Urology, Jaipur

This case underscores the commitment of the Institute of Urology, Jaipur to delivering cutting-edge, minimally invasive care:

• Patient-Centric Approach: Tailored care with emphasis on patient comfort and outcomes.
• Advanced Techniques: Procedures like RIRS eliminate the need for open surgery, reducing costs and recovery times.

Conclusion

This case highlights the efficacy and safety of RIRS for managing upper ureteric stones, even in challenging scenarios involving inflammation. The procedure’s minimally invasive nature, combined with expert surgical skills, ensures excellent outcomes.

The Institute of Urology, Jaipur, continues to set benchmarks in urological care under the leadership of Dr. M. Roychowdhury and Dr. Rajan Bansal, demonstrating excellence in adopting patient-focused, minimally invasive approaches.

References

1. Türk, C., et al. (2023). Guidelines on Urolithiasis. European Association of Urology.
2. Zhang, W., et al. (2022). “Role of prolonged ureteral stenting after RIRS in cases with severe ureteral edema.” World Journal of Urology, 40(6), 1509-1515.
3. Al-Busaidy, S. S., et al. (2021). “Clinical outcomes of RIRS for large upper ureteric calculi.” Journal of Endourology, 35(9), 1201-1208.