RIRS PCNL Dr. Athar Mahmood
RIRS PCNL Dr. Athar Mahmood
For Appointment Call on 0300-4738987
https://www.info4patient.com/
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For Appointment Call on 0300-4738987
https://www.info4patient.com/
https://www.youtube.com/@info4patients
https://www.dailymotion.com/info4patient
https://www.instagram.com/info4patient/
https://www.tiktok.com/@info4patients
Transcript
00:00Info for patient
00:30Upper Pole, Middle Pole, Lower Pole
00:32We can do all this with the help of RIRS
00:34If the stone is 2 cm in size
00:36in the renal pelvis
00:38and there is a problem with the kidney
00:40then we can operate the stone
00:42with the help of RIRS laser
00:44Keep an eye on the ultrasound
00:46and check the stone
00:48which is 2 cm to 2.5 cm in size
00:50in the kidney
00:52If the stone is more than 2.5 cm
00:54then it is a big stone
00:56and has less RIRS efficacy
00:58RIRS is a procedure
01:00in which the stone is directly
01:02punctured in the kidney
01:04without cutting
01:06There is a hole of 1-2 inches
01:08in the kidney
01:10In RIRS, the stone goes
01:12through the urinary tract
01:14In RIRS, the stone goes
01:16through the urinary tract
01:18This is a basic test
01:20CBC, Urine Test, Ultrasound, CT Scan
01:22Most of the patients think
01:24that they have to go to the doctor
01:26But if you go to the doctor
01:28then you will save the cost
01:30Most of the doctors
01:32check the stone once
01:34and see the report for free
01:36There are some doctors
01:38who will charge for the report
01:40I have kept a time of 3-4 days
01:42to check the report
01:44I don't charge for the report
01:46We try our best to
01:48clear the stone
01:50We try our best to
01:52clear the stone
01:54If there is a chance of stone
01:56then precautions are taken
01:58like drinking more water,
02:00using less salt,
02:02exercising,
02:04smoking less,
02:06controlling blood pressure
02:08We have to go to the stent
02:10This is an OPD based procedure
02:12This is an OPD based procedure
02:14We give a short anesthesia
02:16and after 2-3 hours
02:18the patient has to be taken
02:20to the hospital
02:22It costs around 2.50 lakhs
02:24It costs around 2.50 lakhs
02:26It costs around 2.50 lakhs
02:28The cost of this procedure
02:30is more than a heart surgeon
02:32but in a way it is cost effective
02:34You won't get it
02:36If a patient goes to the hospital
02:38without a cut
02:40the patient is productive
02:42then I won't talk about it
02:44This is a cost effective procedure
02:46Drink water in a cold temperature
02:48Keep water with you
02:50You should take online consultation and go for treatment.
02:52Otherwise, you come to us with kidney failure.
02:54Then you can't do anything.
02:55My message is that,
02:56whoever is diagnosed with this,
02:58he should know that there is pain in the kidney.
03:00So, it should be in the mind immediately to get an ultrasound done.
03:02If you are not getting an ultrasound from a certified place,
03:04then you can explore from the internet
03:06and get it checked by a good specialist doctor.
03:08Assalam-o-Alaikum viewers.
03:09Dr. Atal Mehmood is with us in Evercare Hospital.
03:13He is serving as an assistant professor in the services hospital.
03:18He also serves as a private doctor in Evercare Hospital.
03:23Let's ask him about RIRS.
03:25Sir, what is RIRS?
03:26How is it done?
03:27And for which patients is it done?
03:29First of all, thank you very much for introducing me.
03:32RIRS is basically called Retrograde Intrarenal Surgery.
03:38Retrograde means that,
03:39this surgery is done without a cut,
03:41without a surgeon,
03:42and through a urethral tube.
03:44In which we can reach the kidneys through the urethral tube.
03:48RIRS is a very new technology.
03:50It has been introduced in Pakistan in the last 7-8 years.
03:54Before this, it was not available in Pakistan.
03:57Since laser has come in everything.
03:59Like you see skin clinics everywhere that laser is available.
04:02In the same way, the use of laser is basically a technology.
04:05It is coming in every field.
04:06Along with this, it has been treated with great effort in kidney surgery.
04:09RIRS is to break a stone with a camera through an endoscopic urethral tube,
04:14and make dust like sand and remove it.
04:16And this surgery is done as a total day care.
04:19If the patient operates at 10 or 11 in the morning,
04:22then we can send him home in the evening.
04:23If we can send him at 2 or 4,
04:25then also we can send him home in the night.
04:27In uncomplicated, there is no need of any routine cut.
04:31Yes, there is a risk of infection.
04:33For that, we do a pre-op culture,
04:35urine culture test.
04:36After that, his antibiotic is given to him,
04:38and then his operation is done.
04:39And according to that, his medicine is given.
04:41And for this, the rest of the precautions are kept in mind.
04:44So, it is very beneficial for the patient.
04:45And the patient gets discharged early.
04:47Unless the patient is saved from infection,
04:49that is, by consulting with a proper antibiotic and a proper doctor,
04:52and his operation is done in a proper way.
04:55For which stone is it recommended more?
04:58The stone inside the kidney,
04:59this is in the upper ureter and kidney.
05:01We call the upper ureter as endoscopic.
05:03This is basically the stone inside the kidney.
05:05Its size is about 2 cm or 0.5 to 2 cm.
05:09We operate it with RIRS.
05:11It can be up to 2.5 cm.
05:13In the pelvis, the face of the kidney,
05:15the pelvis of the kidney where the urine comes out,
05:18there is a stone inside it.
05:19And even if it is lying on one side of the kidney,
05:21which is called the poles,
05:22upper pole, middle pole, lower pole,
05:24we do all this approach through RIRS.
05:26That is, from the drain of urine,
05:28from the drain of urine to the kidney,
05:30all the stones can be approached through RIRS and laser.
05:34If someone wants to come after watching your video,
05:36how can he understand himself by watching the video
05:39that my stone can come out through RIRS?
05:42Ultrasound is the first screening test.
05:44Urologists are not available everywhere.
05:46Lahore is the city where you will find urologists
05:48in every big hospital.
05:49So, even in small districts,
05:51there is one urologist.
05:52They cannot cater to such a population.
05:54So, people go to the general physician
05:56or go to the general medical specialist.
05:58So, as soon as the ultrasound comes,
05:59see for yourself what is the size of the stone.
06:01If they say it is 2 cm in size,
06:02there is a stone in the renal pelvis or kidney
06:04and there is also a kidney obstruction with it.
06:06This means that this is a stone
06:07that we can operate through RIRS laser.
06:10So, keep an eye on this ultrasound yourself
06:12and the stone in the kidney is 2 cm to 2.5 cm.
06:16You can get it by judging it.
06:18If the stone is more than 2.5 cm,
06:20their treatment...
06:21Yes, I understood.
06:22You asked a good question.
06:23If it is more than 2.5 cm,
06:24then there are big stones
06:25in which the efficacy of RIRS is relatively low.
06:28In that, there is a PCNL procedure
06:29in which the kidney is approached from the camera.
06:31Direct puncture is done in the kidney
06:33and that too without cutting.
06:35There is a hole like a pencil tip in it.
06:37One or maximum two stitches are applied.
06:39So, we put the camera directly in the kidney
06:41and with the stone breakage equipment available with us,
06:44we suck out the stone.
06:46Sir, what is the main difference
06:48between RIRS and PCNL that you have mentioned?
06:50RIRS is total tubeless,
06:52that is, without cutting,
06:53without any tube,
06:54that is, in simple words,
06:56there is no incision.
06:59In PCNL,
07:00there is definitely a stitch of about one inch
07:02because there is a camera in it.
07:04In RIRS, the camera goes through the urine.
07:06Now, the stone that has to be removed from the kidney,
07:08the camera has to be put directly in the kidney.
07:10Basically, the stone is approached
07:12by making a hole directly in the kidney.
07:14But RIRS is through urine.
07:17PCNL is done in the kidney.
07:19For RIRS,
07:20which tests have to be done?
07:22Basic tests.
07:23CT scan.
07:24Nowadays, there is a big modality
07:25that is available everywhere.
07:26CT scan of the kidney is very important.
07:28Urine test
07:29and blood test
07:30CBC.
07:31In this, the infection is checked
07:32with the help of urine test and CBC.
07:34These are the basic tests.
07:35CBC, urine test,
07:36ultrasound and CT scan.
07:37You should not do it yourself.
07:38You should get a CT scan
07:39from a professional doctor or urologist.
07:41It is a costly test.
07:42Its cost is around 15,000 to 20,000 rupees.
07:43It is in the private sector
07:44and in the public sector
07:45it costs around 5,000 rupees.
07:47So, you should get a CT scan
07:48from a doctor
07:49or urologist
07:50and then only get a CT scan done.
07:51Most of the people,
07:52because the doctor's fee is high,
07:53they think that
07:54we have got the ultrasound done,
07:55we have got the CT done.
07:56If we go to the doctor once,
07:57the fee is around 15,000 rupees.
07:58Most of the doctors
07:59check the report once
08:00and then see the report for free.
08:01There are only a few
08:02who will charge for the report later.
08:03So, you should be fully confident
08:04that if you come once,
08:05I have kept a time
08:06of 3 to 4 days
08:07even for a week
08:08that if you check the report
08:09and come again,
08:10I will not charge you.
08:11So, you should get a CT scan
08:12from a doctor
08:13and then send it to the doctor.
08:14And nowadays,
08:15WhatsApp is available,
08:16you can also send it to the doctor.
08:17Sir,
08:18once the PCN
08:19is done,
08:20is there a risk
08:21that there are some
08:22PC's in it?
08:23Yes,
08:24there is a risk
08:25that there are some
08:26PC's in it.
08:27RIRS
08:28and PCNL
08:29basically,
08:30we have to approach
08:31the stone
08:32and the stone laser
08:33has to break it.
08:34So, in this,
08:35we try our best
08:36to completely
08:37clear the stone.
08:38That is,
08:39the same patient
08:40should be operated
08:41with RIRS
08:42which can be completely
08:43cleared.
08:44If it is not possible,
08:45then we give the option
08:46of PCNL.
08:47So, sir,
08:48once the RIRS
08:49is done,
08:50is there a risk
08:51that the patient
08:52will have kidney stones
08:53again?
08:54Yes,
08:55there is a risk
08:56that the patient
08:57will have kidney stones
08:58again.
08:59And the stone
09:00recurrence,
09:01you have asked
09:02the question,
09:03that again and again,
09:04any stone patient
09:05has a chance
09:06to become a stone
09:07all his life.
09:08So,
09:09his precautions
09:10are followed.
09:11Drink more water,
09:12use less salt,
09:13walk,
09:14do physical activity,
09:15exercise,
09:16adopt a healthy lifestyle,
09:17reduce smoking,
09:18control blood pressure.
09:19So,
09:20these are all precautions
09:21so that the stone
09:22does not become again.
09:23Sir,
09:24there is a
09:25minor detail
09:26which we will discuss
09:27later.
09:28The patient
09:29has to come again
09:30to remove the
09:31stent.
09:32So,
09:33after how long?
09:34It has to be removed
09:35within 3 weeks.
09:36But it is
09:37relatively minor.
09:38The patient
09:39comes and
09:40within 1 hour,
09:41he will come
09:42at the given time,
09:43after waiting
09:44for more than
09:451.5 hours,
09:46the stent is
09:47removed and
09:48goes home.
09:49So,
09:50sir,
09:51this stent is
09:52removed,
09:53the stone
09:54is removed,
09:55the stone
09:56is removed,
09:57the stone
09:58is removed,
09:59the stone
10:00is removed,
10:01the stone
10:02is removed,
10:03the stone
10:04is removed,
10:05the stone
10:06is removed,
10:07the stone
10:08is removed,
10:09the stone
10:10is removed,
10:11the stone
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10:15the stone
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10:17the stone
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11:25the stone
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12:17the stone