Retrograde Intrarenal Surgery

The impact of anesthesia type on Retrograde Intrarenal Surgery (RIRS) outcomes remains a subject of ongoing debate. Several studies have compared general anesthesia (GA) and spinal anesthesia (SA) in endourological procedures, with conflicting results regarding operative time, complication rates, and stone-free outcomes. Importantly, the interaction between anesthesia type and stone characteristics-particularly stone size-has not been fully elucidated. Therefore, this study aims to conduct a retrospective comparative analysis of general versus spinal anesthesia in patients undergoing RIRS at Qena University Hospital, with particular emphasis on the effect of stone size stratification on perioperative outcomes.

This multicenter randomized controlled trial will evaluate whether preoperative tamsulosin, intraureteral aminophylline, or their combination can improve ureteral access during primary retrograde intrarenal surgery for renal stones. Adult patients with unilateral renal stones measuring 2 cm or less and planned placement of a 10/12 Fr ureteral access sheath will be randomly assigned to one of four groups in a 2x2 factorial design. Participants will receive either tamsulosin or placebo for 7 days before surgery and either intraureteral aminophylline or intraureteral placebo during the procedure. The main outcome will be successful first-attempt placement of the planned 10/12 Fr ureteral access sheath after study solution instillation, without active ureteral dilatation, sheath downsizing, prestenting with deferred surgery, or abandonment of the procedure due to access failure.

To evaluate the effectiveness of this homework on stone clearance rates after retrograde intrarenal surgery (RIRS) by instructing the patient in the home environment and suggesting percussion and movement/position changes to assist in spontaneous stone passage.