Retrograde Intra-Renal Surgery Using Thulium Fibre Laser as an Alternative to Percutaneous Nephrolithotomy in the Management of Multiple Renal Stones: A Case Report and Literature Review

Abstract

RIRS has increased by 164% in the last decade. RIRS utilizes flexible ureteroscopy while PCNL create a direct access to the kidney via the skin. TFL has been found to be effective for stone lasing. RIRS with TFL avoids skin puncture, nephrostomy tube placement, reduce complications and radiation exposure, enhances recovery and outcome for high-risk patients compared to PCNL. We present a 45-year-old woman with recurrent right flank pain and CT imaging confirmed right renal stones in the lower and middle calyces measuring 2.9cm, 1cm, 0.7cm, 0.6cm and 0.4cm with mild hydronephrosis. She was obese (BMI=35.6kg/m²) and has had multiple previous abdominal surgeries. She declined PCNL on account of skin puncture and opted for RIRS. She had RIRS using thulium fiber with successful stone lasing and ureteric stenting. Patient was discharged 24hours later and 6weeks post-operative imaging showed complete stone clearance. RIRS is feasible for obese patient, those declining PCNL or wish to avoid skin puncture including those with multiple renal stones using TFL.