Ureteroscopy and RIRS: their role in emergency practice

Key points

Ureteroscopy and RIRS (retrograde intrarenal surgery) allow minimally invasive treatment of ureteral and renal stones.

In emergency urology, they are particularly useful:

• after infection has stabilized;
• in uncomplicated obstruction when patency must be restored quickly.

When RIRS is appropriate

• Renal stones, including complex cases.
• Situations in which PCNL is contraindicated or undesirable.
• As a stage in treating a large stone burden (large stones may require several procedures).

Infection

• In sepsis with obstruction, the first priority is drainage.
• RIRS with active lithotripsy during uncontrolled sepsis must not be performed.
• Proceed to definitive treatment after clinical improvement.

Technical principles

• Flexible ureteroscope, laser lithotripsy.
• A ureteral access sheath, when needed, to facilitate controlled intrarenal work.
• Select laser power and mode: dusting or fragmentation with extraction.

Safety

• Avoid excessive intrapelvic pressure and prolonged procedures.
• A staged strategy is preferred for complex stones.

Practical conclusion

RIRS should not be viewed as a universal substitute for PCNL. Select the method according to:

• stone size and location;
• anatomy;
• infection;
• risk of complications;
• the surgeon's experience and the institution's resources.

Algorithm