Overview
Calculus in the renal pelvis is frequently managed using retrograde intrarenal surgery (RIRS) with laser lithotripsy, which is considered the gold standard for stones up to 20 mm 1. Effective treatment requires the regulation of intraoperative parameters, specifically intrarenal pressure (IRP) and intrarenal temperature (IRT), to minimize surgical and infectious complications 1.Management
Surgical Gold Standard: Retrograde intrarenal surgery (RIRS) with laser lithotripsy is the primary treatment for renal stones up to 20 mm 1.
Pressure Control: Maintain low intrarenal pressure (IRP) through the use of ureteral access sheaths (UAS), low irrigation pressure, and keeping the working channel occupied 1.
Temperature Regulation: Control intrarenal temperature (IRT) by balancing laser power settings and irrigation flow rates 1.
Laser Settings: Utilize low power settings (<20 W) with minimal irrigation flow (5–10 ml/min) to maintain safe IRT during continuous laser activation 1.
Advanced Tools: Robotic systems and suction devices may be employed to improve the management and monitoring of intraoperative IRP 1.Key Recommendations
Retrograde intrarenal surgery (RIRS) with laser lithotripsy should be utilized as the gold-standard treatment for renal stones up to 20 mm 1. (Evidence: Strong)
Intraoperative monitoring and control of intrarenal pressure (IRP) are mandatory to avoid barotraumatic and septic complications 1. (Evidence: Expert opinion)
To maintain safe intrarenal temperatures during continuous laser activation, clinicians should use low power settings (<20 W) combined with adequate irrigation flow 1. (Evidence: Moderate)References
1 Panthier F, Pauchard F, Traxer O. Retrograde intra renal surgery and safety: pressure and temperature. A systematic review. Current opinion in urology 2023. link