Successful retrograde intrarenal surgery (RIRS) for a 2-centimeter stone in a chronic renal failure (CRF) patient.

Seyed Mohammad Kazem Aghamir

doi:10.1016/j.ijscr.2021.106375

Abstract

Introduction and importanceRetrograde intrarenal surgery (RIRS) is the best complementary method to Flexible Ureterorenoscopy (URF). In the case of renal insufficiency in patients with urolithiasis, the stone treatment strategy can be different because it should have the least injury to the kidney and be minimally invasive. There was no previous evidence of RIRS in stone-breaking in a chronic renal failure (CRF) patient. For the first time, we presented a successful RIRS in the monokidney CRF case with >2 cm stone.Case presentationWe have done the RIRS over a 55-year-old monokidney woman. She already has lymphoma, chemotherapy, lithotripsy, right renal nephrostomy, and a left kidney stone removal. She had hydronephrosis with a >2 cm stone in her left kidney. The patient underwent RIRS surgery and Holmium lithotripsy (strength 8 and impact strength 13,000) on pinking layers of stone.Clinical discussionDuring the RIRS surgery, we put a ureteric stent (the patient already had a double J before), and we fixed the ureteral catheter with the Foley catheter and removed the ureteral catheter 4 days after the surgery. The result of the surgery was satisfying and after three days the patient goes into a stable condition.ConclusionRegarding the least injury to the kidney during RIRS surgery, it can be the best treatment option for urolithiasis in CRF patients.

Highlights

Introduction and importanceRetrograde intrarenal surgery (RIRS) is the best complementary method to Flexible Ureterorenoscopy (URF)
Treatment strategies are minimally invasive like extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL), and Retrograde intrarenal sur gery (RIRS) [1]
Chronic renal failure (CRF) or kidney failure is the progressive loss of kidney function which is defined as decrease glomerular filtration rate and increased urinary albumin excretion [2]

Summary

Introduction

The prevalence of kidney stone disease, known as urolithiasis, has increased mostly in developed countries over the last years. In RIRS the scope is placed through the urethra (the urinary opening) into the bladder and through the ureter into the urine-collecting part of the kidney. The scope is moved retrograde (up the urinary tract system) to within the kidney (intrarenal). Chronic renal failure (CRF) or kidney failure is the progressive loss of kidney function which is defined as decrease glomerular filtration rate and increased urinary albumin excretion [2]. Several reports indicated successful RIRS in urolithiasis but not in CRF patients. We reported the first successful RIRS in a CRF patient with stone >2 cm. We considered the treatment strategy of RIRC in CRF patients and the best candidate antibiotic medication with the required efficacy in this patient

Case presentation

Method

Findings

Discussion