A Little Story
Having spent almost 40 years in treating Kidney stones, first 6 years performing open stone surgery, next 10 years practicing PCNL, URS & ESWL & now for over almost two decades treating Kidney stones by RIRS & URS only, I have never been so comfortable as today. RIRS has become so safe both for patients & Doctors in the present scenario of practice in India.
RIRS is an abbreviation for Retrograde Intrarenal Surgery. It was 1991 when I first held a flexible ureteroscope in my hands. I never imagined at that time that this is the future of Kidney Stone Treatment. This flexible scope in 1991 had no deflection mechanism.
From 1991 to 1996, I used this scope through the instrument channel of Nephroscope in two cases & could only examine ureteric stones. I could just see them & had to satisfy myself with the feeling of using a flexible ureteroscope as I had no laser fibers & no baskets which could pass through the channel of this scope.
It was in 1997 when I used a Holmium laser for the first time in my clinic. The laser was from Lisa Laser Company, Germany & was a Demo Unit. I was excited to use this laser as this laser would break 100% stones, fibers were very small caliber as compared to Ultrasonic burrs which were then used for intracorporeal lithotripsy ( Breaking or fragmenting the stones inside human body ). This was a breakthrough & a big hope for treating Kidney stones with ureteroscope in the future. The same year, I landed in Gottingen, then in West Germany & spent almost a week with Dr. Heino Teichman, the founder of Lisa Lasers. During this period, I was introduced to Dr. Andreas Gross by Dr. Teichmann. That is when for the first time in my career I had the feeling of deflectable flexible ureterorenoscopy, today is commonly known as Flexible Ureteroscope.
The very next year, I organized a Workshop Rigid & Flexible Ureteroscopy at our clinic in Panipat under the aegis of North Zone Chapter of the Urological Society of India. This was the first workshop in India on Flexible Ureteroscopy held on 12 & 13th Dec. 1998 at R P Stone Clinic, Panipat. I managed to get Dr. Andreas Gross from Germany & Dr. David Albala from the USA. We broke two flexible ureteroscopes both from Richard Wolf GmbH in this Workshop. The Lisa laser brought by Dr. Heino Teichmann who himself was present in the Workshop did not work properly.
The take-home message was not in favor of Flexible Ureteroscopy. The occasion was graced with the presence of Dr. Mahesh Desai, Prof. Dr. N P Gupta & Prof. Dr. S K Sharma. Dr. M S Aggarwal, Dr. Samir Rai & Dr. Anil Elhence were a great help to me.
My Disappointment with Flexible Ureteroscopy did not last long & I procured another flexible Ureteroscope from Karl Storz the very next year. I kept struggling with flexible scopes including DUR -8 till 2004 when I had Viper in my hands gifted to me by Mr. Ludwig Bonnet from Richard Wolf & this changed the history of Kidney stone treatment in India. In 2006, I was invited to present my work on Flexible Ureteroscopy in the 39th Annual Conference of Urological Society of India in Varanasi. The word ” RIRS” ( Retrograde Intrarenal Surgery/ Flexible Ureteroscopy ) started appearing in the field of Kidney Stone Treatment.
From the year 2006 to 2009, I worked extensively on Viper & then had the privilege to use Cobra, a double-channel flexible ureteroscope which had the provision of using basket & laser fiber simultaneously. This scope could be passed into the Kidney with a preloaded laser fiber.
In the year 2011, the Urological Society of India organized a Workshop on Flexible Ureteroscopy ( RIRS 2011 -April 27-28 ) at our R P Stone Clinic, Panipat. And there was no looking back after that. I started working with Digital Flexible Ureteroscopes & I had almost replaced PCNL with RIRS.
Today, I am treating the majority of Kidney stones, Single or multiple or staghorn by RIRS.
From 2002 to 2015, I conducted several workshops on RIRS, delivered numerous Lectures & Guest Lectures, made video presentations almost all over the Country from Srinagar ( J & K ) to Kochi ( Kerala ) & Abroad. And today I am training Young Urologists in RIRS at R P Stone Clinic with the help of Cook Medical Devices India Pvt. Ltd. who organize COOK VISTA Training Programmes frequently held at our clinic.