RIRS: Retrograde Intrarenal Surgery

RIRS or Retrograde Intrarenal Surgery is an endoscopic surgery performed to remove renal stones by reaching the kidney from the ureter. It is a very effective method to treat or manage urinary stones. Urinary stones are solid masses made of crystals which usually develop in the kidneys, though they can develop anywhere along the urinary tract – kidney, ureter, bladder and urethra. Depending on the location of the stone, the stones are referred to kidney stone, ureteral stone or bladder stone. Also, varying by the location of the stone, the process of stone formation is called urolithiasis, renal lithiasis or nephrolithiasis. These stones are formed due to excessive accumulation of certain minerals in the body and the lack of fluids to dissolve the accumulated minerals that can include calcium, oxalate and uric acid. Moreover, other factors such as poor diet, severe diarrhoea, excessive weight, family history or certain medications can also lead to the formation of stones along the urinary tract.

Procedure of RIRS

Before the procedure,the doctor will conduct to determine the position of the stones, the general health condition of the patient and the overall response to anaesthesia. These assessments will be made at least 2 weeks before scheduling a retrograde intrarenal surgery.Once, the tests are clear, the doctor will conduct the stenting process 2-weeks before the actual RIRS surgery.The stenting is done to allow easier access to the urteroscope to enter the kidneys, as the stents since ureteroscopy is already dilated. Moreover, on the day of the surgery, the patient is required to not eat or drink anything for at least 4-6 hours. 

To begin the surgery, the patient is given anaesthesia and the urologist uses an endoscope – a thin, flexible tube – toreach thebladder through the urethra. Once there, the endoscope is then further directed to the area of urine storage in the kidney.

In the RIRS procedure, the surgeon uses a viewing tube called fibre optic endoscope and a laser fibre – Holmium – to treat the renal stones. Once the large stone is removed, small fragments of the stones are taken off through stone baskets. In some cases, a stent may be pushed in the kidney to improve drainage. Post the procedure, the endoscope is crushed, blasted or evaporated by using a laser probe or can also be manually removed through forceps. The surgery is performed by a urologist who has specialized expertise in RIRS. The surgery does not involve any incisions and hence, has a very fast recovery time. With RIRS a vast majority of renal stones can be cleared without open surgery.

Purpose of RIRS

With the recent technological developments in the management of renal stones, RIRS has emerged as a very reliable, safe and efficient method. The main purpose of a renal stone treatment is to clear the stones completely with minimum morbidity – RIRS clears renal stones through flexible ureterorenoscopes and lithotripters including holmium laser, ensuring no trace of stones are left. Moreover, advancement in related equipment such as guide-wires, urethral access sheath and stone baskets have enhanced the effectiveness of the RIRS procedure. As of today, RIRS is a prime method of treatment for renal stones that are less than 2 cm and cannot be successfully treated via other methods. 

Suitability of RIRS

An RIRS procedure is best suited for cases where:

  • Earlier attempts to remove renal stones have failed
  • Stones are too large
  • There is a tumour in the kidney
  • There are strictures in the kidney
  • The patient involved is a child
  • The patient has bleeding disorders
  • The patient is obese
  • The patient has complex anatomical kidneys
  • The patient is on anticoagulants

Advantages of RIRS

Retrograde intrarenal surgery is one of the novel methods to treat renal stones. Some of the advantages of the RIRS method are:

  • Minimally invasive
  • Simple and quicker procedure
  • Shorter recovery time
  • Less painful
  • Less morbidity
  • Minimal bleeding
  • No risk to the renal tissue
  • Fewer complications

Risks of RIRS

Complications or risks associated with RIRS are fairly uncommon and occur only in very cases.

  • Fever
  • Flank pain
  • Urinary infection
  • Transient hematuria
  • Acute urinary retention
  • Ureteral pelvicalyceal abrasion
  • Fornix rupture
  • Ureter avulsion
  • Bleeding
  • Sepsis
  • Trauma to kidneys

That said, RIRS may not be a surgical option if the size of the renal stones is more than 20mm in diameter or there are several small stones, especially along the previous tubes or after urinary tract infections. Such cases are not the ideal situations for RIRS and can be treated better through a different method.

Overall, RIRS has established itself as a reliable and safe method of treatment for renal stones. The advantages of RIRS outweigh its disadvantages. It is a very feasible treatment option with high success rates and lower complications involved. However, the suitability of RIRS for a patient can be determined by medical professional only.

Effective Ways To Prevent Kidney Disorder

Effective Ways To Prevent Kidney Disorder

Date: 15th September, 2019

Kidneys are the filtration system of our body and very critical for our survival, however, they are often neglected and in a lot of cases, kidney diseases go undetected for a long period of time until they become very advanced requiring immediate medical attention. Some of the risk factors that can cause kidney disorders include diabetes, high cholesterol, high blood pressure, heart disease, and a family history of kidney disorders. People aged 60 years or above also have a high risk of developing kidney disorders. 

Most kidney disorders are not detected until they reach an alarming stage; however, a urine test or a blood test can indicate the functioning of the kidneys and could indicate kidney disorders. It is advisable to get regular check-ups done to detect kidney disorders early on and prevent them from intensifying. That said, it is important to prevent oneself from the basic causes of kidney disorders – diabetes, blood pressure, and heart diseases. Some of the effective ways to prevent kidney disorders are:

Follow a healthy diet

A large number of kidney disorders are caused because of unhealthy food choices such as oily food, junk food, fast-food, carbonated drinks, processed food, caffeine, sugary items, etc. Instead, focus on eating foods that are healthy for the whole body and especially the kidneys. Healthy food options include fresh fruits, green leafy vegetables, whole grains, low-fat dairy food, etc. You should aim to reduce your intake of salt and added sugar. On an average day, a normal person’s intake of sugar should be less than 10 percent of the total calories and sodium intake should be less than 2,000 milligrams. Also, avoid foods that are high in trans fat, saturated fats, and cholesterol.

Indulge in at least 30 minutes of daily physical activity

Just a healthy diet does not guarantee healthy kidneys, it is also important to burn the calories taken from food daily to avoid build-up of fat. Exercise is essential to keep the body agile and functioning properly. A daily routine of exercise is essential for the health of blood vessels in the body. One can also start exercising for lesser time initially and then gradually increase. Simple healthy habits such as taking the stairs instead of the elevators also go a long way in preventing kidney disorders.

Maintain a healthy weight

Excessive body weight is a huge risk factor for diseases such as diabetes and high blood pressure, which in turn are the two most critical triggers for kidney disorders. Moreover, extra weight creates pressure on the kidneys to work harder and filter excessive waste above the normal level. Hence, it is important to maintain healthy body weight and stay fit. On a general scale, a BMI – Body Mass Index – of above 25 is considered to be alarming and indicates overweight. 

Get enough sleep

On an average, 7-8 hours of sleep is essential for a human body to stay fit and function properly. Lack of proper sleep is a major risk factor for diabetes and high blood pressure – both of which are prime causes of kidney disorders.

Quit smoking

Smoking is very harmful to the body and one must quit smoking to prevent kidney disorders. Smoking reduces the blood flow to major organs of the body including the kidneys, making their functioning hard. Also, smoking can impact the medications used to cure high blood pressure, causing uncontrolled blood pressure which ultimately worsens kidney disorders. More so, smoking causes higher levels of albumin and creatinine in their urine. Higher levels of albumin and lower excretion of creatinine from the body, is an indication of early kidney disorders and must be prevented.

Limit alcohol intake

Alcohol can disturb the normal process of the kidneys, making them less able to filter blood. Also, alcohol restricts the kidneys to maintain the right amount of water in the body by dehydrating the body. Excessive alcohol also affects the blood pressure, causing a shoot in the blood pressure which in turn harms the kidneys. Moreover, alcohol intake is known to adversely impact high blood pressure medications, creating an increased risk of kidney disorders. 

Reduce stress

Stress is a very common term today but often a silent killer in the generation. Stress and the reaction to it can adversely impact the health of the kidneys. Stress or hypertension is prime triggers for high blood pressure, which is a major factor affecting kidney health. Stress also affects the blood circulation and hampers the heart’s health – another risk area for the kidneys. Hence, it is critical to reduce stress in life to prevent kidney disorders. Indulging in hobbies, meditating, exercising, practicing yoga, etc. are several ways in which you can deal with acute stress. Moreover, you can also consult your doctor on ways to tackle the problem.

Apart from these important factors, it is also essential to keep certain things in mind while aiming to prevent kidney disorders. These include maintaining a positive outlook, setting time aside to relax, sharing feelings, and listening to music to calm the body and improvise its functioning. Moreover, it is critical to get tested regularly and consult your doctor on ways to keep your blood glucose, blood pressure and heart health in check, so that kidney disorders can be prevented rigorously.

Precautions To Be Taken After Kidney Stone Operation

Precautions To Be Taken After Kidney Stone Operation

A kidney stone is a solid mass composed of tiny crystals. These are formed when there is an excessive quantity of a certain mineral in the body while at the same time there is a lack of liquid to dissolve these minerals. These pebble-like objects are not actually stones but the pain caused is very intense and one might feel as if they are actually stones. These substances are yellow or brown in colour and are often smooth though they could be rough too. The most common types of kidney stones are calcium stones or uric acid stones.

Kidney stones can be the size of sand, gravel or the size of a pearl or even larger and is often very painful since it blocks the flow of urine. In many cases, the stone may travel through the urinary tract and come out but in many cases, small non-invasive surgeries may be required. While kidney stones are fairly common and can occur in both genders and people of all ages, it is vital to understand the causes of it, the symptoms to detect a stone, treatment and most important precautions to take after the kidney stone operation since, the stones have a tendency to reoccur if proper precautions are not taken.

Kidney stones are caused when there is a high level of certain minerals in the urine. These minerals generally include calcium, oxalate, and urine acid. When the concentration of these minerals in the body increases and there is a lack of fluids to dissolve the minerals, these turn and form into stones causing extreme pain and a lot of urine problems. Apart from this, some factors such as diet, extreme diarrhoea, obesity, family history or certain medications – can also cause stone formation. In many cases, people do not even realize the presence of stone in the body if they are really small – almost the size of a salt grain. Most people might not experience any symptoms of a kidney stone until the stone starts to stir and move around in the kidney or into the ureter.

That said, some of the common kidney stone symptoms include:

  • Intense pain on the side or below the ribs
  • Extreme pain in the groin and lower abdomen
  • Pain while peeing and increased frequency of pee
  • Pink, brown, red or cloudy pee
  • Nausea with stomach pain
  • Fever
  • Chills

The only effective way to avoid kidney stones is to evade the build-up of minerals by consuming a lot of water and fluids every day, as well as following a healthy and regulated diet with restricted sodium, exclusion of certain vegetables such as spinach. One should drink at least 8 glasses of water each day to meet the daily water requirements of the body. In many cases, kidney stones pass automatically and do not cause any problems. However, it depends on what the size and the symptoms of the problem are. That said, this is not a guaranteed method to get rid of kidney stones, the doctor might suggest certain medications and in extreme cases, might even suggest surgery. In cases, where a kidney stone operation is undertaken, it could either be:

Shock wave lithotripsy (SWL): Where high-energy sound waves are aimed to break down small or medium size stones into tiny pieces that can be released while urinating. 

Ureteroscopy: In this method, a thin, flexible tube is inserted through the urethra, bladder, and ureter to reach the stone and extract it. In cases of a larger stone, a laser is passed to break it.

Open surgery: When the non-invasive methods fail and the stone is large in size, the doctor might person an open surgery to remove the stone by cutting through the side to take the stone out while you are sedated.

No matter the form of procedure, there is a need to take extreme precautions post the kidney operation to ensure you are healthy, recovering well and there is no recurrence of the stones. Some of the procedures one must take include:

  • Do not drive back after the operation. Instead, ask someone to pick you up and take home from the hospital
  • Take enough rest and avoid any physical activity at least for 2-3 days. Even after this duration, if you do not feel energetic enough to take on normal routine activities, take some more rest
  • Drink a lot of water after the procedure an in the weeks to follow after the operation. Overall, maintain the quantity of 8 glasses of water each day
  • Take all medications as suggested by the doctor even if you tend to feel fine. Completing the full course is essential
  • Occasionally strain your urine to check for any stones. In case, there are any stones, get it checked via your doctor
  • East less salt
  • Reduce foods that are high in calcium
  • Drink fluids such as lemonades (without sugar), eat lemons and oranges
  • Do not consume a lot of protein, eat lean meats instead
  • Opt for a low-fat diet
  • Avoid alcohol
  • Avoid calcium supplements for some time and seek advice on when to restart the doses
  • Avoid high doses of Vitamin C supplements
  • Visit the doctor on all appointments as suggested

Further, one must consult the doctor about any precautions to follow post the kidney stone operation. Precautions might also vary condition on condition and proper consultation is very critical. However, in the general scenarios, one must carefully follow these rules to recover well after a kidney stone operation.

Know all about Kidney Stone

Know all about Kidney Stone

Kidney stones are hard masses of tiny crystals formed due to excessive accumulation of certain minerals in the body and lack of fluids to dissolve the minerals. These minerals include calcium, oxalate, and uric acid. When the concentration of these minerals in the body exceeded a certain level and there is not enough presence of fluids to dissolve these minerals – stones are formed. Apart from this, some other factors such as poor diet, severe diarrhoea, excessive weight, family history or certain medicines can also cause the formation of kidney stones.

Kidney stones are brown or yellow in colour and have a smooth as well as a rough texture. These can be the size of sand, gravel, pearl or even bigger and is usually painful since it blocks the flow of urine. In some cases, people do not even realize the presence of kidney stones unless they start to stir and move up the ureter causing discomfort and pain.

Some of the common symptoms of kidney stones include:

  • Extreme pain in the back
  • Extreme pain below the ribs
  • Pain while urinating
  • Increased urination
  • Cloudy, discoloured or foul-smelling pee
  • Pain in the groin or lower abdomen
  • Nausea
  • Intense stomach ache
  • High fever
  • Shivering and chills

Even though, kidney stones are common in people of ages and gender, it is still possible to prevent it and reduce the pain from the right treatment.

 Prevention of Kidney Stones

A few adjustments in the diet and lifestyle can go a long way in preventing the formation of kidney stones in the body. Some of the basic steps include:

 Drinking a lot of water: The most effective way to prevent the formation of stones is to drink enough fluids especially water to ensure there is a proper dissolution of the minerals in the body. A person must drink 8 litres of water or enough water to pass two litres of urine on a daily basis. For people who sweat more, additional intake of water needs to be included. Lack of water implies low urine output which leads to the accumulation of urine salts that cause stones. You can also include lemon water and orange juice in your diet since they contain citrate which is known to prevent stones.

 Eating a calcium-rich diet: Calcium-rich foods such as low-fat milk, cheese, and yogurt are known to prevent the formation of stones, contrary to the belief that excess calcium results in stones of calcium oxalate. Moreover, calcium supplements with food are also helpful in this case.

 Avoiding sodium intake: Foods that have high sodium content are known to trigger the formation of stone since excess salt prevents the calcium from being reabsorbed from the urine to the blood, leading to an excess concentration of calcium in the urine and formation of kidney stones. Food such as below should be avoided to reduce sodium intake:

  • Processed foods
  • Canned soups
  • Canned vegetables
  • Condiments

 Limit oxalate-rich foods: Oxalate is naturally found in foods such as spinach, chocolate, sweet potatoes, coffee, peanuts, wheat bran, etc. and excessive oxalate combines with calcium in the urine to form kidney stones. Hence, limiting the intake of oxalate-rich foods helps to reduce the chances of stone formation.

 Reduce animal protein: Animal protein in foods such as beef, poultry, fish and pork can become acidic in the body, increasing the concentration of urine acid which then causes uric acid and calcium oxalate kidney stones.

 Avoid vitamin C supplements: Vitamin C supplements are known to increase the chances of stones. However, natural vitamin C amount present in food is permissible.

Moreover, on the advice of the doctor, you can also take some preventive medications for stones.

 Treatment of Kidney Stones

Some kidney stones go unnoticed and usually pass on their own with little help; however, in many other cases treatment becomes necessary depending on the severity of the symptoms, the size of the stones and the cause of the stones.

A few treatment options for kidney stones are:

 Small stones with fewer symptoms

These kinds of stones do not require invasive treatment and can be removed via the following methods:

 Drinking lots of water: The doctor might advise you to drink more than 2 litres of water to pass the stone thought urine

 Pain Killers: Passing a stone can be very painful and hence, doctors recommend a pain killer to ease the process.

 Medication: A doctor might suggest medicines called alpha-blockers that help relax the muscles

in the ureter, enabling the stone to pass through quickly and easily.

 Large stones with intense symptoms

 Shock wave lithotripsy (SWL): In this method, high-energy sound waves are used to create strong vibrations that aim to break down small or medium size stones into tiny pieces that can be released while urinating. The process is about 60 minutes long, mildly painful, and can cause bruising on the back, blood in urine, bruising on the abdomen, etc.

 Ureteroscopy: In this method, a thin, flexible tube with a camera is inserted through the urethra, bladder, and ureter to reach the stone and extract it. In cases of a larger stone, a laser is passed to break it. The doctor might also place a stent (tube) in the ureter to reduce swelling and enhance the healing process.

 Percutaneous Nephrolithotomy: In this surgical method, a telescope and other instruments are used to remove a large kidney stone by making an incision on the back. The recovery might take more than 2 days.

Kidney stones might be a very normal health problem today but with proper awareness about its treatment and most importantly prevention, this problem can easily be avoided.

Prostate Biopsy – Tool To Rule Out Protrate Cancer

Prostate Biopsy – Tool To Rule Out Protrate Cancer

A prostate biopsy is a procedure that is used to collect a sample of suspicious tissue from the prostate to check for cancer and symptoms. A prostate is a tiny, walnut-shaped gland in men which is responsible for producing fluid required to nourish the sperm. A prostate biopsy collects a suspicious tissue of the prostate to check for prostate cancer – which is one of the most common forms of cancer in males.

Prostate cancer is highly treatable, provided the cancer is detected early and adequate medical help is received. The main diagnostic tests for prostate cancer are the prostate-specific antigen (PSA) test and the digital rectal examination (DRE). If the results of these tests are positive, the doctor might do a prostate biopsy to diagnose prostate cancer effectively. Sometimes, prostate cancer does not produce symptoms. Thus, it is critical to get regular health check-up, especially for men above the age of 45.

Purpose of a Prostate Biopsy

The prime objective of a prostate biopsy is to detect prostate cancer. A prostate biopsy may be conducted to when:

  • The PSA test shows higher values than normal
  • There are lumps or other abnormalities detected during a rectal exam
  • The previous biopsy was normal, but the PSA levels are still high
  • An older biopsy showed non-cancerous, abnormal prostate tissue cells 

The procedure of a Prostate Biopsy

In a prostate biopsy, the patient is asked to lie on the side or on the stomach, with knees folded and pulled up, closer to the chest. Post the cleaning of the area, a gel is applied to allow a flexible, thin ultrasound probe to be inserted the rectum. Post this, high-frequency sound waves are sued to produce images of the area. The doctor will then numb the target area through an injection to minimize discomfort during the procedure. The images are then used to guide the prostate needle to collect thin, cylindrical portions of tissue. The patient might experience slight discomfort, every time the needle collects a sample. On an average, 10-12 samples are collected either from a targeted area or from several areas in the prostate.

Post the procedure, the patient should not indulge in heavy physical activities for at least 24 to 48 hours; the doctor will also recommend antibiotics for a few days to fasten the recovery. However, as an aftereffect of the procedure, a person might experience:

  • Soreness or light bleeding from the rectum
  • Blood in urine
  • Blood in stool
  • Some blood in semen

These symptoms will tend to fade in a few days. However, you must call the doctor, in case you have:

  • Fever
  • Problem in urinating
  • Consistent and excessive bleeding
  • Worsening pain

The samples collected will then be analysed by a specialist, who will check for any cancer or other abnormalities. The prostate biopsy sample can indicate the type of cancer and how aggressive the cancer is. Based on the report of the pathologist, the doctor will decide the future course of treatment.  

Recovery of Prostate Biopsy

The recovery procedure post a prostate biopsy will depend on the type of anaesthesia used. In the case of general anaesthesia, the patient will be kept under observation to examine the blood pressure, breathing, and pulse. Once stabilised, the patient is either discharged or kept under precautionary observation for some time, depending on the patient’s health condition.

In case local anaesthesia was used to do the biopsy, the patient is discharged the same day and can return to routine activities and diet unless otherwise instructed though you might experience mild after-effects of the surgery that will go away with time. Also, there will be a constant urge to urinate, which will also pass after a few hours.  

Side Effects of Prostate Biopsy

A prostate biopsy is a safe procedure though it can have some side effects or risks, such as:

  • Bleeding at the site of the biopsy
  • Blood in semen which makes the semen appear red or rust in colour.
  • Blood in urine
  • Problem in urinating
  • Infection of the urinary tract or prostate

These side effects and risks are not a matter of serious concern and are considered the normal post a prostate biopsy; these will fade on their own in a matter of days. In case they do not go away or intensify along with other side effects such as fever, worsening pain, etc. – the doctor must be consulted.

In cases where a prostate biopsy causes sepsis – a life-threatening infection, immediate medical attention should be provided. Signs of sepsis include:

A rapid or abnormal heart rate

  • Fever
  • Chills
  • Confusion
  • Shortness of breath
  • Pain and discomfort
  • Excessive sweaty skin

In all, a prostate biopsy is a safe method to analyse cancer and other related prostate problems; it is also very effective in removing benign tumours. That said, complete knowledge about the procedure, its purpose, side effects and the recovery period must be obtained from the doctor.

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