PCNL/PNL refers to Percutaneous nephrolithotomy (PNL) which is a minimally-invasive technique of removing stones from the kidney with the help of making a small puncture (less than 1 cm) in size through the skin from the back (as shown). It is suitable for the removal of stones, which are greater than 2 cm in size. This is usually done under the influence of general anaesthesia or through spinal anaesthesia.


Ureteroscopy is a technique of inspecting the upper urinary tract (ureter and kidney). This procedure is generally performed with a ureteroscope (semi-rigid or flexible)that is passed through the urethra and the bladder, that directly enters into the ureter; however, only the lower two-thirds of the ureter is accessible by this procedure.

URS(ureteroscopy and stone removal) : The Kidney stones that are smaller in size and are present in the ureter as well can be removed successfully in one piece, and the bigger ones are generally fragmented by laser before removing it with the help of ureteroscopy.

RIRS or flexible ureteroscopy:
Retrograde intrarenal surgery (RIRS) is a relatively newer technique for the removal of stones. Retrograde intrarenal surgery (RIRS) is a method of removing kidney stone with the help of a fiberoptic endoscope. RIRS Surgery permits a surgeon to perform surgery inside the kidney without an incision. The RIRS has proved to be quite effective for cases that are difficult-to-treat such as Tumors, bleeding disorders and the occurrence of stones in children.

Indications for RIRS

  • Restriction or tumours present in the upper urinary tract
  • Occurrence of stones in children
  • Stones larger in size for ESWL (lithotripsy)/Lithotripsy failures
  • Extreme obesity with multiple co-morbidities.
  • Patients having bleeding disorders or on anticoagulants.

  • Procedure of RIRS

    RIRS is a procedure that is performed by an experienced and the best urologist in India with unique expertise in RIRS. The method is carried out under general or spinal anaesthesia.

    Ureteric access sheath is located on guidewire below continuous fluoroscopy.

    Flexible Ureteroscope scope is then located through the urethra (the urinary opening) in the bladder and then into the ureter within the kidney(as shown).

    The stone can be then seen through the Ureteroscope, which is then handled or squashed with the help of an ultrasound probe or evaporated by HOLMIUM laser.

    Small stones are grasped by Urology baskets (Nitinol Baskets)

    After the completion of RIRS Procedure, Double J stent is placed to facilitate the smooth drainage from kidney and avoid blocking in the ureter.

    Advantages of RIRS

  • No need for a skin incision
  • Rates of Stone clearance rates are very high
  • Safe removal of a Kidney stone
  • Faster Recovery
  • Minimum hospitalization
  • Low-risk procedure
  • Lower operating time
  • No injury to renal tissue