A renal calculus forms when minerals and salts calcify within the kidneys, and is known as a kidney stone. These stones can be rather painful and may result in urinary tract infections or deterioration of the kidneys if they are not treated promptly.
Luckily, there have been strides in the medical field that can aid in treating the stones depending on their size and location. This blog covers the most popular remedies for kidney stones, specifically focusing on RIRS, FANS RIRS, and PCNL, which are meant for larger kidney stones.
Getting to Know Kidney Stones
In the urinary system, kidney stones vary in origin, size, and even shape. Some well known types are calcium oxalate, uric acid, struvite, and cystine stones. These stones can vary in size, from as small as a grain of sand to as large as a golf ball. While some kidney stones may pass through the urinary tract on their own, others require medical intervention due to their size, location, or associated symptoms. Dehydration, food intake, family history, and other medical issues can lead to the formation of these stones. Common Symptoms often present severe pain on one side or the back, blood in urine, vomiting, nausea, and heightened urge to urinate.
Best Approaches For Kidney Stones Treatment
The specific method of remedying issues concerning kidney stones is primarily determined by the size of the stone, the condition of the patient, its location, and its composition. Here, we analyze three major types of surgeries done in a less invasive fashion:
- Retrograde Intrarenal Surgery (RIRS)
RIRS is a technique performed for the treatment of urinary tract stones located in the renal pelvis and in some other areas. For RIRS, a flexible ureteroscope is passed over the patients head and is placed into the bladder. The telescope is then directed into the ureter and kidney. This allows the surgeon to use a scope advanced into the renal pelvis or one of the renal calyces where the stones are located and laser lithotripsy may be used to fragment the stones into smaller pieces which will be removed or allowed to pass spontaneously.
Benefits of RIRS
- No abdominal cuts which results in lesser postoperative pain and faster recovery
- For stones less than 2 cm in diameter, success rates are very high.
Additionally, those patients suffering from bleeding diathesis or who are not amenable for any other procedure are also taken care.
Points to note
- For larger stones, multiple sittings may be needed in such cases.
- For some anatomical sites of the body, stones which are too big will not be useful for the process.
- Flexible Antegrade Nephroscopy (FANS) RIRS
FANS RIRS is a state-of-the-art method that incorporates components of both antegrade and retrograde approaches. First, a small flank incision is made, after which a flexible nephroscope is directly introduced into the kidney. This permits access to stones lodged in difficult areas.
Advantages of FANS RIRS
- Greater access to upper urinary tract stones, including those in the renal pelvis and calyces.
- Higher rates of stone clearance because of improved visualization and flexibility of instruments.
- Reduced incisions with faster recovery times.
Considerations
- Requires specialized equipment and expertise.
- Possibilities of bleeding or infection which are rare.
- Percutaneous Nephrolithotomy (PCNL)
PCNL is the most effective treatment of choice for larger kidney stones that are usually 2 cm and above. With this technique, a small incision is made on the back of the patient and the kidney is visualized through a nephroscope. The stone fragments can then be removed efficiently.
Advantages of PCNL
- For patients with large or complex stones, PCNL has high success rates.
- Allows the removal of multiple stones at the same session.
- The stone can be removed through a duct which improves efficiency.
Considerations
- Potential complications include excessive blood loss, development of a wound or organ infection, and uncommonly, damage to organs which is unfortunate, but is part of the consideration.
- It does involve external incisions which lengthens recover periods as opposed to RIRS.
Comparative Insights
These are the factors that need to be considered when choosing between FANS RIRS, RIRS and PCNL. Patient’s wellbeing, stone location, and stone size.
- As for stone size, PCNL is most useful for larger stones while RIRS is appropriate for stones 2 cm and under. PCNL is the best option when it comes to stone location because of its success rate at the lower pole of the kidney.
- As for patient’s wellbeing, a more non-invasive approach such as RIRS is recommended for people who might have other health issues.
- As for recovery time, since RIRS and FANS RIRS are less invasive, there is a reduced recovery time when compared to PCNL. The particular treatment approach that is most suitable for any patient’s individual characteristics must always be established with a urologist.
For a comprehensive evaluation by a urologist is essential to determine the most appropriate treatment approach based on individual patient factors.
Bottom Line: Talk To Expert urologist
With advancements in modern medicine comes a more effective and non-invasive treatment options for kidney stone management. Each of these procedures, including RIRS, PCNL, and FANS RIRS come with their own spearhead approaches to removal of kidney stones.
If you are looking for someone who can handle complex cases in urology with a personal touch, then look no further because you have already found it. Having more than a decade of experience in endourology, andrology, and renal harvesting, Gurgaon-based urologist Dr. Deepanshu Gupta is an authority in urology care.
He undertakes advanced techniques in kidney stone management such as RIRS and PCNL, and tailors specific treatment modalities to every patient.
In closing, effective management of a case of renal stone is reliant on many interdependent variables, especially patient medical condition, as well as location and size of the stone. An experienced urologist like Dr. Deepanshu Gupta can offer expert counsel with clarity which can lead to successful management outcomes.
Book a consultation today for expert advice on kidney stone removal!