Percutaneous nephrolithotomy (PNL) is a minimally-invasive procedure to remove stones from the kidney by a small puncture (less than 1 cm) through the back skin(as shown). It is most suitable to remove stones of more than 2 cm in size . It is usually done under general anesthesia or spinal anesthesia.


Ureteroscopy is an inspection of the upper urinary tract (ureter and kidney), usually performed with a ureteroscope (semirigid or flexible)that is passed through the urethra and the bladder, and then directly into the ureter; usually the lower 2/3 of the ureter is accessible by this procedure.

URS(ureteroscopy and stone removal) : Smaller stones in the ureter and kidney can be removed in one piece, while bigger ones are usually fragmented by laser before removal during ureteroscopy.

RIRS or flexible ureteroscopy:
Retrograde intrarenal surgery (RIRS) is a newer method of removal of stones. Retrograde intrarenal surgery (RIRS) is a procedure to removal stone from kidney by using a fiberoptic endoscope. RIRS Surgery allows the surgeon to perform surgery inside the kidney without making an incision. The RIRS can be effective for difficult-to-treat cases, like Tumors, Patients with bleeding disorders and Stones in children.

Indications for RIRS

  • Stones too large for ESWL (lithotripsy)/Lithotripsy failures
  • Patients with gross obesity and multiple co- morbidities
  • Strictures or Tumors in upper urinary tract.
  • Stones in children.
  • Patients with bleeding disorders or on anticoagulants.

  • Procedure of RIRS

    RIRS is performed by an urologist with special expertise in RIRS. The procedure is usually done under general or spinal anesthesia.

    Ureteric access sheath is placed on guidewire under continuous fluoroscopy.

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

    The stone is seen through the Ureteroscope and can then be manipulated or crushed by an ultrasound probe or evaporated by HOLMIUM laser.

    Small stones are grabbed by Urology baskets (Nitinol Baskets).

    After the RIRS Procedure Double J stent is placed for smooth drainage from kidney and avoid blocking in ureter.

    Advantages of RIRS

  • No skin incision is required.
  • Stone clearance rates are very high.
  • Safe removal of Kidney stone.
  • Low-risk procedure.
  • Lower operating time.
  • No damage to renal tissue.
  • Fast Recovery.
  • Minimum hospitalization.