Category: Clinical Stones: Outcomes
Introduction & Objective :
RIRS has become an efficient and safe option in the management of 1-1.5 cm renal stone.Despite recent innovations,primary access to kidney remains a challenge.Most institutes practice interim ureteric stenting to allow Ureteral Access Sheath (UAS) placement amounting to multiple procedures.
We describe our experience with T10 as an adjunct to assess the ureter and a tool to guide decision making for UAS placement in an unstented Asian population undergoing RIRS in the Modified Ergonomic Lithotomy position (MEL).With this we hope to have a successful single stage access and thereby avoid staged procedures.
20 renal units were subjected to primary RIRS by MEL technique between April 2017-2018 (Table1).
Patients were positioned in the MEL position(Diagram1).Following insertion of a guidewire,T10 was inserted into the ureteric orifice(UO) under fluoroscopic guidance.If found feasibl,it was gently advanced to the pelvi-ureteric junction(PUJ). A check semirigid ureteroscopy was followed by insertion of UAS.T10 enabled one step dilatation of the ureter following which, the ease of insertion of UAS and ability to perform successful RIRS was assessed.
T10 was successfully advanced to PUJ in all 20 renal units. Age, sex or BMI>30 were not limiting factors.There were no perioperative complications. In 2 cases of PUJ stenosis, the T10 acted as a serial dilator.Successful T10 advancement ensured easy,safe and successful placement of 11/13fr UAS.
In the era of miniaturised instruments,stone clearance in a single sitting is an increasingly attractive,feasible and economically viable option.Our small early dataset proves T10 is an underutilized,multifunction tool which aids in one step dilation and acts as an adjunct to gauge UAS placement.Successful T10 passage correlates with safe and easy placement of 11/13 fr UAS thus making primary RIRS more feasible and reducing need for staged procedures.This also completely averts the need for balloon dilatation. Thus, we advocate T10 use in all primary cases of RIRS.Future multicentre trials may help to prove its efficacy for primary RIRS success rates.