Maximizing RIRS Outcomes: Tilt for Enhanced Stone Removal and Optimizing Surgeon’s Ergonomics

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.