Kidney stones are also known as renal calculi. Due to the increased levels of certain elements in the blood, stones of these elements are deposited in the kidneys. They can be dislodged into the ureters and bladder. Small stones usually pass through the urinary bladder and urethra on their own. Sometimes, stones can cause urine output blockage, which might require intervention to prevent the worsening of a patient’s condition. The condition in which stone formation occurs in the kidneys is called Nephrolithiasis.

• Calcium Oxalate
• Uric Acid
• Struvite
• Cystine

• Surgery: Open abdominal surgery
• Ureteroscopy: Retrograde Intrarenal Surgery
• Percutaneous Nephrolithotripsy: Invasive surgery performed through small incisions made to reach the kidneys
• Shockwave Lithotripsy: Extracorporeal Shock Wave Lithotripsy

In the following conditions, retrograde intrarenal surgery may be useful.

• When renal calculi are present in the ureter
• When renal calculi are blocking the flow of urine from the kidney to the urinary bladder
• When the size of renal calculi is less than 10 millimeters
• When renal calculi are causing hydronephrosis (swelling of the kidney)
• When renal calculi are present in the inner parts of the medulla and cortex of the kidney
• When medical tests such as ultrasound, X-rays, Computed Tomography show the presence of renal calculi
• When the patient has an underlying kidney disease
• When the patient has compromised kidney function
• When a patient is allergic to dyes injected to perform further tests

The following symptoms may necessitate Retrograde Intrarenal Surgery:

• Severe pain
• Low urine output
• Blockage of urine causing backflow into the kidney
• Any underlying disease that could explain the composition of the stone
• Infection or inflammation of the bladder or kidneys
• When shockwave therapy is ruled out
• Pus in the kidneys (pyonephrosis)
• A block in the ureter and/or kidney unilaterally or bilaterally

This procedure is performed to remove renal calculi in any part of the urinary tract. It is non-invasive. The surgery is performed under general anesthesia. Multiple small-sized scopes are inserted into the urethra, which are then guided into the ureter, and they eventually reach the kidneys. The scopes consist of one fitted with a camera at the end, one with a fiber optic laser to break down the stones, and another with a basket-like claw to capture the stone debris and guide it back outside through the urinary bladder and urethra.

Provided there are no other complications, the patient can be discharged the same day, and the procedure becomes outpatient. Sometimes, at the end of the surgery, the surgeon might choose to place a stent in the ureter to allow urine to pass through more easily. Such urine can carry any small stone debris left. The procedure usually lasts 1-2 hours.

Possible Complications

• Sepsis
• Localized infection in any part of the urinary tract
  Ureter narrowing (stricture)
• Bleeding from one or both kidneys
• Scopes damaging the delicate walls of the ureters or even rupturing them
• ● Bruising

• A 24-hour urinalysis must be performed.
• Urine output must be checked for signs of blood, stones, and discharge.
• Ultrasound must be performed to rule out signs of internal bleeding or infection.
• Blood tests must be performed to ensure proper kidney function.
• Stents can be removed a week to ten days post-surgery or as and when the physician decides.
• ● Stones removed must be sent for analysis to determine their composition.
• When the composition of stones is clear, the underlying cause for the precipitation of the stones can be treated.
• Drinking enough water to flush out the kidneys is important.

• Ensure enough water intake to flush out the kidneys thoroughly every day.
• Avoid certain kinds of food that can cause the deposition of stones.
• Ensure enough urine output, which can otherwise lead to backflow, causing stone formation.
• Maintain proper hygiene to prevent urinary infections.

Nephrolithiasis is a preventable condition and can be easily treated without too many complications. However, recognizing symptoms early is important. Timely consultation with a urologist or nephrologist is crucial. Pain caused by the passing of a kidney stone is one of the worst kinds of pain. Any complications that arise even before surgical intervention will only make the procedure and post-operative care more difficult.

It is important to send the stones for analysis so that the causes for stone deposition may be determined and treated. This is important to prevent the condition from becoming chronic.

A retrograde intrarenal surgery may be extremely safe, but it is still only performed when the stones cannot be flushed out by more natural methods.