Suction-Enabled Retrograde Intrarenal Surgery: Technical Principles, Physiological Rationale, and Evidence-Based Applications | Chapter 7 | Newer Frontiers in Urology, Volume III

 

Background: Retrograde intrarenal surgery (RIRS) is a cornerstone for managing renal calculi <2 cm, yet it faces limitations including elevated intrarenal pressure, suboptimal stone clearance, and infectious complications. The integration of suction, particularly via Flexible and Navigable Ureteral Access Sheath (FANS), aims to mitigate these challenges. This chapter provides a critical appraisal of the role of suction in RIRS.

 

Methods: A synthesis of current literature and technical principles was conducted to evaluate the mechanisms, clinical outcomes, advantages, and limitations of FANS-assisted RIRS.

 

Results: FANS facilitates continuous outflow of irrigation fluid, stabilising intrarenal pressure and reducing the risk of pyelovenous backflow and sepsis. It enhances intraoperative visibility and may improve stone-free rates by actively evacuating fragments. However, these benefits must be weighed against increased costs, a learning curve, and a currently limited evidence base from large randomised trials.

 

Conclusion: Suction-assisted RIRS represents a significant technical advance, particularly beneficial in cases with enormous stone burdens, lower-pole stones, or infected systems. The decision to utilise suction—"to suck or not to suck"—should be individualised, as it is not a mandatory addition for all RIRS procedures but a valuable adjunct in select clinical scenarios.

 

 

Author(s) Details

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education &Research Chennai, India.

 

Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH7

Maximizing RIRS Outcomes: Tilt for Enhanced Stone Removal and Optimizing Surgeon’s Ergonomics | Chapter 2 | Newer Frontiers in Urology

Introduction: Retrograde intrarenal surgery (RIRS) has emerged as a transformative minimally invasive approach in the management of intrarenal calculi. The evolution from traditional methods like Extracorporeal Shock Wave Lithotripsy (ESWL) to RIRS represents a significant advancement in urological practice, particularly with the integration of advanced laser technology and flexible ureteroscopes.

Aim: This chapter aims to provide a comprehensive overview of RIRS, examining its technical aspects, and recent innovations, particularly the Tilted RIRS (T-RIRS) technique, and addressing the challenges and future directions in the field.

Results: The chapter presents detailed insights into patient positioning techniques, including the novel T-RIRS approach, which optimizes stone accessibility through specific table tilts based on stone location. It explores stone fragmentation methods (dusting and fragmentation), navigation techniques, and technological innovations such as advanced laser systems and disposable ureteroscopes. The review also addresses crucial aspects of surgeon ergonomics and complication management, supported by current literature and clinical evidence.

Conclusion: RIRS has established itself as a standard of care in treating lower pole renal calculi for sizes up to 1.5 cm, offering excellent outcomes while maintaining minimal invasiveness. The introduction of T-RIRS and other technological advancements continues to enhance procedural efficiency and surgeon comfort. Future developments in artificial intelligence, imaging techniques, and personalized treatment approaches promise to further revolutionize this field.

 

Author (s) Details

 

Arvind Ramachandran
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Karthik M Chavannavar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/mono/978-93-49238-86-2/CH2

Phaseolus vulgaris Linn: An Overview | Chapter 10 | Advanced Concepts in Pharmaceutical Research Vol. 1

 Black beans (Phaseolus vulgaris L.) are most widely ate in China, India, and America due to their singular taste and potent energy benefits attributed to their higher content of phytochemicals. Researchers have widely explored the phenolic sketch and biological features of black beans. Since experiences, restorative spices have been found and used in established medical practices. The French grain, or Phaseolus vulgaris Linn. (Family: Fabaceae), is a carbohydrate and protein-rich meal crop with healing features that is intensely enticing. This plant holds a variety of minerals, including carbohydrates, proteins, flavonoids, saponins, tannins, and phenolic acids.The sources of Phaseolus vulgaris Linn. have having Hostile to urolithiatic action and Against strength action. This survey gives a summary of phytochemistry and pharmacological impact of Phaseolus vulgaris Linn., The plant can be furthermore researched for different pharmacological exercises as it contains assortment of compound elements and it is a generally applying food yield and dispassionate cures of this plant are fit together with nature.

Author(s) Details:

M. Devi,
Department of Pharmacology, Faculty of Pharmacy, Dr. MGR Educational and Research Institute, Vellapanchavadi-600 077, Chennai, Tamil Nadu, India.

R. Praveen,
Department of Pharmacology, Faculty of Pharmacy, Dr. MGR Educational and Research Institute, Vellapanchavadi-600 077, Chennai, Tamil Nadu, India.

R. Sneha Sri,
Department of Pharmacology, Faculty of Pharmacy, Dr. MGR Educational and Research Institute, Vellapanchavadi-600 077, Chennai, Tamil Nadu, India.

G. E. Thillai Govindarajan,
Department of Pharmaceutics, Faculty of Pharmcy, Sri Ramachandra Institute of Higher Education and Research, Porur-600 116, Chennai, Tamil Nadu, India.

Please see the link here: https://stm.bookpi.org/ACPR-V1/article/view/12104

Effect of Diet on the Tendency for Stone Formation in Patients with Calcium Oxalate Stones in the Urinary Tract| Chapter 5 | Current Topics on Chemistry and Biochemistry Vol. 7

 Patients accompanying emergent calcium oxalate grains should trail a depressed-oxalate diet to prevent repetition. The aim concerning this study on patients accompanying calcium oxalate metals search out study the impact of able to be consumed calcium content on the formation of calcium oxalate crystal in excretion utilizing an artificial supersaturation study of new postprandial urine samples and to obey the plant structure of the crystal made utilizing reverse optical microscopy. The study was created as a potential interventional randomized crossover dispassionate trial accompanying periodic measures. Sixty patients accompanying calcium oxalate metals and no metabolic irregularities in excretion were acted with lithotripsy at a after second care center from May 2016 to May 2019. Following a 14-time journey fast, excretion samples were calm afterwards the patient was given either a reduced or extreme-calcium food for brunch, understood by a high-oxalate food four hours later.The ocular bulk principles and calcium-creatinine percentage of excretion samples obtained following a extreme calcium food are considerably above those acquired following a low calcium food (p<0.001). These findings were mirrored in the breadth, shape, and number of made crystals. During a supersaturation study of postprandial excretion samples following a extreme-oxalate diet, no crystal were made when excretion calcium levels were depressed. Kidney stone result is extensively affected by a extreme calcium consumption in the diet. Even when consuming a extreme-oxalate diet, a reduced-calcium food has a lower risk of provoking kind stones.

Author(s) Details:

Jim Joe,
Department of Biochemistry, Government Medical College Kottayam, Kerala, India.

Sathish Kumar Gopala,
Department of Urology, Government Medical College, Thiruvananthapuram, Kerala, India.

Please see the link here: https://stm.bookpi.org/CTCB-V7/article/view/9227

Role of Multidetector Non-Contrast CT Scan in Estimation of Attenuation Value of Urinary Calculi and Predicting the Outcome of ESWL | Chapter 15 | Highlights on Medicine and Medical Research Vol. 13

 Introduction: Urolithiasis is a frequent condition that is becoming more common around the world. For patients with acute renal colic, non-contrast computed tomography (NCCT) is the gold standard imaging modality. For urolithiasis, extracorporeal shock wave lithotripsy (ESWL) has emerged as the therapy of choice. According to NCCT, the attenuation value in Hounsfield units is a major predictor of ESWL success. The goal of this study was to use NCCT to assess the attenuation value of urinary calculi and to compare it to the results of ESWL. Materials & Method: This study is a prospective analytical study of 75 patients with urolithiasis who have undergone NCCT and ESWL at Ramaiah Medical college and hospitals, Bengaluru, Karnataka. The study period was from November 2013 to June 2015. Results: The successful outcome post ESWL in different groups of attenuation value are 100% in group 1(<500HU), 92.6% in group 2(500-1000HU) and 33.3% in group 3(>1000HU). The failure rate was 7.3% in group 1 and 66.6% in group 3. The calculus density above 1000 HU decreases the rate of successful outcome post ESWL. Conclusion: The NCCT-estimated attenuation value (HU) of urinary calculi predicts ESWL outcome, allowing patients to be identified as candidates for ESWL.

Author (S) Details

Dr. Deepti Naik
Department of Radio-diagnosis, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India.

View Book :- https://stm.bookpi.org/HMMR-V13/article/view/1554