Retrograde intrarenal surgery: Past, present, and future

Abstract

With the recent technological advancements in endourology, retrograde intrarenal surgery has become a more popular procedure for treatment of urolithiasis. Furthermore, since the introduction of new laser systems and advanced flexible ureteroscopy with miniaturized ureteroscopes, the treatment indications for retrograde intrarenal surgery have expanded to include not only larger renal stones of >2 cm but also upper urinary tract urothelial carcinoma, ureteral stricture, and idiopathic renal hematuria. Clinicians must keep up with these trends and make good use of these technologies in the rapidly changing field of endourology. Simultaneously, we must consider the risk of various complications including thermal injury due to laser use, ureteral injury caused by the ureteral access sheath, and radiation exposure during retrograde intrarenal surgery with fluoroscopic guidance. This review focuses on the past, present, and future of retrograde intrarenal surgery and provides many topics and clinical options for urologists to consider.

Keywords: Flexible ureteroscopy; Kidney stone; Laser; Retrograde intrarenal surgery.

Fig. 1. Flow chart of kidney stone management. (A) Middle, upper pole stone, and part of lower pole. (B) Lower pole stone. PCNL, percutaneous nephrolithotomy; RIRS, retrograde intrarenal surgery; SWL, shock wave lithotripsy; URS, ureteroscopy. ^a:If uncorrected bleeding diatheses or continuous anticoagulation/antiplatelet therapy, URS should be use. ^b:If negligible kidney function, nephrectomy is one of treatment.