If inadequately treated, renal stones, or commonly known as kidney stones, may lead to pain and health issues. One of the newest methods of treating kidney stones is Retrograde Intrarenal Surgery (RIRS). RIRS is a minimally invasive procedure that can be performed with a flexible ureteroscope which accesses the kidney stones and breaks them into smaller parts without any external cuts. Since the working area is inside the urinary tract, another common question arises – What form of anesthesia is required for patients undergoing RIRS?
In this post, we will analyze the relevance of anesthesia in RIRS, the different kinds of anesthesia utilized, its advantages, and how it affects the experience of the patients holistically.
RIRS: A Less Invasive Kidney Stone Removal Technique
Retrograde Intrarenal Surgery (RIRS) is a newer method for endoscopic removal of kidney stones that does not require external incisions. The steps of the procedure include:
Inserting a flexible ureteroscope through the urethra and the bladder to the kidney.
Employing laser technology such as the Ho:YAG laser to disintegrate the kidney stones into smaller pieces.
Washing the particles away through urine or retrieving them with specialized baskets.
As RIRS is performed through the urethra into the kidney’s renal pelvis, anesthesia is important to facilitate the patient’s comfort and the quality of their surgical experience.
Why Is Anesthesia Required for RIRS?
Even though RIRS is considered to be a relatively non-invasive operation, it still requires certain levels of anesthesia to make the procedure as comfortable as possible for the patient. These are the reasons that make the use of anesthesia indispensable during the RIRS procedure:
Pain Management
Without any level of anesthesia, the vertical insertion of ureteroscope and the subsequent laser fragmentation of the kidney stones is bound to produce a lot of discomfort and pain to the patient.
Anesthesia ensures that the patient does not feel burn, pain or any form of irritation throughout the procedure.
Muscle Relaxation
Due to the position of the ureteroscope, spasms or contraction of the surrounding muscles of the ureter my occur.
Anesthesia not only helps to relax these muscles, it also improves the maneuverability of the surgeon for the kidney, as well as, the access to the kidney.
Preventing Sudden Movements
Any small movement by the patient has the potential to make the process of targeting the kidney stones with the laser highly difficult.
With the help of anesthesia, it’s guaranteed that the patient will remain still and comfortable throughout the process, which in turn guarantees accurate fragmentation of the stone.
Reducing Anxiety and Stress
The majority of patients tend to feel anxious and fearful about anything that involves a surgical procedure.
Anesthesia ensures that they calm down and prevents any form of psychological distress throughout the surgery.
Better Surgical Outcomes
With the patient being highly relaxed and free from pain, the surgeon is able to focus solely on stone removal which would, in turn guarantee a higher success rate with less complications.
Anesthesia Options for RIRS Surgery
Different types of anesthesia may be indicated for RIRS considering the patient’s condition, medical history, and size/location of the kidney stones. The two most frequently used methods are:
1. General Anesthesia (GA):
The patient is entirely unresponsive during the procedure.
An endotracheal tube is routinely placed to assist ventilation.
Recommended for extended or intricate RIRS procedures, especially for large stones.
Guarantees full analgesia with complete rest of the muscle during the operation.
2. Regional/Spinal Anesthesia:
The patient is awake, but is unable to bear any pain from the waist down.
Lower body is rendered numb by injecting a local anesthetic into the spinal region.
Recommended for shorter or relatively more simple RIRS procedures.
Quicker recovery compared to general anesthesia.
3. Local Anesthesia with Sedation (not frequently performed):
Urethra and bladder are subjected to local anesthetic to achieve numbness.
The patient is made mildly sedated to permit relaxation while remaining awake.
This is only done in exceptional cases when patients are unable to endure general anesthesia due to health issues.
Which Anesthesia Is Best For RIRS?
The factors determining the type of anesthesia include:
- Size and Location of Kidney Stones: General anesthesia may be needed for larger stones while smaller ones can be treated using spinal anesthesia.
- Patient’s Health Condition: Patients with cardiac or pulmonary conditions may be recommended against using general anesthesia.
- Patient’s Preference: Some patients opt for spinal anesthesia in order to avoid the side effects of general anesthesia.
General anesthesia is preferred in most scenarios since it provides a fully pain-free RIRS procedure and optimal conditions for surgery to be performed.
Why Using Anesthesia Is Beneficial For RIRS
Anesthesia contributes greatly to the safety, comfortability, and success of the RIRS procedure. Some benefits include:
- Painless Procedure: The patient experiences no pain while the physician removes the stones.
- Efficient Surgery: Without disturbances caused by the patient moving, the physician can operate more effectively.
- Amenable Recovery: Patients awake in comfort after the operation and do not experience much pain, thanks to proper anesthesia.
- Better Outcomes: A lower success rate and higher probability of complications is caused by inaccuracy during stone fragmentation.
Is Anesthesia Safe for RIRS Procedures?
Provided that the anesthesiologist is licensed and on-site, anesthesia is safe for RIRS. As with any medical procedure, some risks include:
- Nausea or dizziness that is temporary following general anesthesia.
- Mild throat discomfort due to soreness from the breathing tube.
- Extremely unlikely outcomes such as low blood pressure or allergic reactions.
- Detailed pre-operative assessments such as variable blood tests, thorough heart check-ups, and comprehensive medical history reviews ensure safety.
Post-Anesthesia Recovery & Effects
After RIRS, patients are monitored in a recovery room until they are fully alert and aware.
Post anesthesia general drowsiness as well as mild fatigue may occur.
Hydrating helps stone fragments to be expelled, so most patients are able to exercise normal ranges of activities within a couple of days.
Bottom Line: Advanced RIRS Treatment with Dr. Deepanshu Gupta
With or without the use of general or spinal anesthesia, the aim is to keep the patient relaxed while enabling the surgeon to effectively extract kidney stones without any hindrance. Anesthesia remains fundamental in guaranteeing smooth, effective, pain-free, and successful RIRS.
Some of the best treatments for kidney stones in Gurgaon can be provided by Dr Deepanshu Gupta, a urologist expert in RIRS and other advanced techniques of kidney stone surgery. He has been practicing urology for several years and provides the best care for his patients utilizing modern techniques of minimally invasive surgery, making the treatment of kidney stones both safe and effective.
Get in touch with Dr. Deepanshu Gupta if you or your family members are looking for professional guidance and unparalleled treatment for difficult-to-treat kidney stones.
Schedule your consultation now!