Category : Endoscopic Surgery
Kidney and ureteric stones are common and painful. For many patients, the safest and most effective way to treat stones today is flexible endoscopy—also called flexible ureteroscopy (fURS) or retrograde intrarenal surgery (RIRS). This technique does not require any cuts on the skin. A thin flexible telescope is passed through the natural urinary passage (urethra → bladder → ureter → kidney) and the stone is dusted or fragmented with a laser and removed. It replaces older open or laparoscopic operations in most cases.
What Is Flexible Endoscopy (RIRS/URS)?
Under anesthesia, a small camera is gently advanced into the ureter and kidney. A laser (Holmium:YAG or Thulium fiber) breaks the stone into tiny pieces that are removed or left to pass naturally. A temporary internal tube called a stent may be placed to ensure smooth drainage; this is removed in a short outpatient visit.
When Is Flexible Endoscopy Recommended?
Your urologist may suggest flexible endoscopy if any of the following apply:
- Kidney stones up to ~20 mm (2 cm), especially if shock‑wave therapy is unlikely to work or has failed.
- Lower‑pole kidney stones 10–20 mm where endoscopy is more effective than shock waves.
- Ureteric stones that are not passing with medicines or are causing ongoing pain/infection/obstruction.
- Complex anatomy or prior surgery where other methods are less suitable.
- Patients preferring a single, definitive minimally invasive procedure.
Benefits of Flexible Endoscopy
- No skin incisions → minimal pain and scarring; usually a day‑care or overnight procedure.
- High stone‑free rates for stones ≤20 mm; may need staged sessions for heavier stone burden.
- Lower infection and bleeding risk than open surgery and quicker return to normal activity.
- Can treat stones in difficult locations and address multiple stones in one sitting.
Understanding the Procedure
- Pre‑op evaluation: imaging (CT/ultrasound), urine culture; a single dose of antibiotic is typically given peri‑operatively.
- Anesthesia: general or spinal depending on case.
- Procedure time: ~30–90 minutes depending on stone size, number and location.
- Stent: sometimes placed for comfort and drainage; removed after ~7–14 days in a quick visit.
- Discharge: most patients go home the same day or next morning.
What to Expect After Surgery
- Mild burning on urination and light pink urine for a few days is common.
- If a stent is placed, you may feel urinary frequency or flank discomfort; this settles after removal.
- Pain is usually mild and well controlled with tablets; activity can resume in 2–3 days.
- Call your doctor urgently for fever (>38°C), severe pain not relieved by medicines, inability to pass urine, or heavy bleeding with clots.
Recovery & Prevention
- Hydration: target 2–2.5 litres/day unless advised otherwise.
- Short course of pain medicines; antibiotics are not continued routinely if urine culture is sterile.
- Follow‑up imaging (ultrasound/X‑ray/low‑dose CT) in 2–6 weeks to confirm stone clearance.
- Dietary guidance based on stone type (e.g., limit excess salt; moderate animal protein; maintain normal calcium intake).
Is Flexible Endoscopy Right for You?
Choice of treatment depends on stone size, location, composition and your health. For stones larger than ~20 mm, percutaneous nephrolithotomy (PCNL) generally achieves the highest stone‑free rates. For some smaller stones, shock‑wave lithotripsy (SWL) may also be an option. Your urologist will individualize the plan for you.
Who Performs the Procedure?
Endourologists—urologists trained in minimally invasive stone surgery—perform RIRS/URS using high‑definition flexible scopes, laser systems, and specialized retrieval devices.
Why Choose Siva Hospital (Nagercoil/Kanyakumari)?
- Comprehensive imaging and stone‑risk evaluation
- Experienced endourology team with modern flexible scopes and lasers
- Day‑care pathway and attentive post‑procedure follow‑up
- Patient‑first, evidence‑based care
Key Evidence (for patients who like the details)
- International guidelines recommend URS/RIRS or SWL for most kidney stones ≤20 mm; PCNL for >20 mm.
- For lower‑pole stones 10–20 mm, URS achieves higher stone‑free rates than SWL.
- Day‑case URS is safe in most patients with low readmission rates.
- A single pre‑operative antibiotic dose is usually sufficient when urine culture is sterile