Sheathless RIRS

• 11 Oct 2021 09:56:32 PM
• |Endo Urology

Flexible ureteroscope has revolutionised the management  of renal stones. Ureteral Access Sheath (UAS) is commonly used for easy access of the Pelvicalyceal system. This helps in easy passage of the scope and enable drainage of irrigants out of the kidney helping to reduce the intra renal pressure.

For introduction of the UAS, we have to dilate the ureter or pre-stent it. This is associated with our apprehension of injuries to ureter either by trauma or ischaemia. Both eventually result in ureteric strictures which is a nightmare. This brings in the question- Are we going back to the old days when we had only large ureteroscopes?  We were doing the same exercises in those days and facing poor outcomes. In the modern era of flexible ureteroscopy, Our limitation is not the availability of small scopes but our dependency on Ureteral Access Sheath for performing the procedure.

With simple techniques we can perform sheathless RIRS which is safe and easy to perform. In this video I am discussing the basic steps of sheathless RIRS. 

https://youtu.be/X8i0T_Mfnaw

                                                                                                        Dr Vinod K V, Kerala

Comments(2)

• 

  Venugopal P

  12 Oct 2021 08:54:27 AM

  Dear All,

  This video by Vinod Talking on ‘Sheathless RIRS – A Primer’ is worth listening and understanding. Though there will be some who might think that Access Sheath is a necessity while performing RIRS, some have found that Access sheath is not a real necessity. I am sure topic will generate interest among the Pundits and will lead to a fruitful discussion.

  For the Convenience of the Viewers I am posting the Link for easy viewing

  https://youtu.be/X8i0T_Mfnaw

  With warm Regards,

  Venu

   

• 

  Ravindra Sabnis

  12 Oct 2021 07:17:54 PM

  Sheath less RIRS is now a days has become a new trend. But just because it is new does not become good or worthy of practicing. Vinod has made very good video & narrated all points about FURS without sheath.  Most people are now shifting for sheathless RIRS. However most important point which Dr Vinod said about introduction of URS in ureter. That is where trouble starts. Rest of the procedure – whether sheath is present or absent does not make any difference. Personally I feel it is not easy to pass URS in ureter – either without wire or by  the side of wire. Vinod said keep bladder empty but it does not happen as you take time to manipulate & while water is going on, in short time, bladder becomes full & there is no way to empty bladder. I find going over the wire is easiest way. However configuration of tip of URS is not appropriate to be passed just like that. Any instrument which has no round tip are not meant to be passed without obturator. They are traumatic. See example of cystoscope, resectoscope, Semirigid URS. I have highlighted this point in detail in my book on instrument. In your video you have not advocated about dilatation of ureter & said that if URS does not go in ureter better to put DJ & wait. My feeling is not going through U/O may be due to technical reasons But if y9ou dilate the ureter – URS may go & you may avoid staged procedure.

  But I appreciate for a very nice, high quality & coming out with all the points in great details. Hearty congratulations. This video needs to be preserved & kept in video library of RIRS