“Is upper ureteric kink a real nightmare for the Urologists while performing Flexible Ureteroscopy (fURS)? A single center experience of 15 cases of Retrograde Intra Renal Surgery (RIRS) in unstented patients with upper ureteric kink”.

Abstract

INTRODUCTION: As a successful Initial Puncture defines the success of Percutaneous Nephro Lithotripsy
(PCNL), similarly successful deployment of the Flexible Ureteroscope (fURS) defines the success of Retrograde
Intra Renal Surgery (RIRS). We report our experience of 15 cases of RIRS in upper ureteric kink in unstented
patients and evaluate the feasibility, technical difficulties, outcome and follow up. METHODS: Out of 16 patients
with upper ureteric kink, RIRS could be performed in 15 patients (94%). Intra operative maneuversrequired,
Stone free rates (SFR) at 1 month post-operative follow up and number of auxiliary procedures required was
noted. RESULTS: In 13 patients (87%), sensor guide wire was placed through semi-rigid Ureteroscope. In 2
patients (13%), guide wire was negotiated across the ureteric kink with fURS placed distal to ureteric kink. We
placed Double Lumen Ureteric Catheter and safety guide wire in 11 patients (69%) which helped keeping the
ureter straight. SFR after 1st procedure was in 10/15 patients (67%) and in 14/15 patients (94%) after 2nd
procedure.SFR after 1st RIRS in stone burden < 2 cm is 9/11 (82%) as compared to ¼ (25%) in stone burden > 2
cm (p < 0.01). 5/15 patients (33%) developed contrast extravasation, successfully managed with DJ stenting. No
serious complication was noted. CONCLUSION: RIRS is feasible and safe for upper tract calculi in patients with
ureteric kink for stones < 2cm. Maneuvers such as Retro Grade Pyelography (RGP), Double Lumen Ureteric
catheter, safety guide wire improve the success rate.