The cornerstone of Urology services is Endourological surgeries. Endourological surgeries are minimally invasive procedures performed through the urine pipe (Urethra) using miniature endoscopic cameras and instruments. Using this technology, most urological surgeries such as prostate surgery, surgery for tumors, surgeries for stones and stricture can be performed. The advantages of these minimally invasive surgeries are decreased post-operative pain, reduced hospital stay and quicker post-operative recovery and return to normal activities.

Some of the Endourological procedures done for stone disease include:

1. Semirigid Ureterorenoscopy - is a procedure where stones in the Ureter are removed using a semirigid ureteroscope by breaking them into fragments using a laser.

   How is Ureterorenoscopy performed?

   1. A general/spinal anesthesia is administered.
   2. An endoscope is inserted into the bladder through the urethra to pass the soft wire inside the kidney.
   3. Using the wire as a guide, a semirigid ureteroscope is passed into the ureter and the stone is identified.
   4. Fragmentation of the stones can be done with the help of a laser fiber.
   5. A small wire basket can then later be used to remove the fragmented stones
   6. A plastic soft stent is required to be left after the operation for 1-4 weeks inside the ureter.
2. Percutaneous nephrolithotripsy - Multiple stones or single stones bigger than 2cm in size or Staghorn stones are treated using this procedure.

   How is percutaneous nephrolithotripsy performed?

   1. A small cut is made at the back and a passage is created from the skin up to the level of the kidney.
   2. An instrument called as nephroscope with a fiber optic camera is threaded in this passage to identify the kidney stones.
   3. The stone is fragmented using a laser or lithoclast and fragments are removed.
   4. A tube is left in the kidney to facilitate urine drainage. After 48-72 hours, the tube is removed.
   5. The urine catheter is removed the day after.
3. Mini PCNL - Small renal calculi can be treated with mini-percutaneous nephrolithotripsy (Mini PCNL). The main difference between PCNL and Mini PCNL is the reduced size of the instrumentation used for the procedure. Small renal stones can be easily removed using miniature instruments, with a resultant advantage of reduced blood loss and post-operative pain. An additional advantage of the mini-PCNL is that it is a tubeless procedure.
4. Retrograde intrarenal surgery (RIRS) – RIRS is a procedure done using a flexible ureterorenoscope. The main indication for this procedure is to remove upper ureteric and renal stones which cannot be reached by a semirigid ureteroscope.

   How is retrograde intrarenal surgery performed?

   1. The procedure is generally performed under general anesthesia.
   2. An endoscope is inserted into the bladder through the urethra to pass the soft wire inside the kidney.
   3. Using the wire as a guide, the ureter is dilated and an instrument called as Access sheath is placed in the ureter. This sheath facilitates access for the flexible ureteroscope to reach the kidney.
   4. Upper ureteric or renal stones are fragmented with the help of a laser fiber.
   5. A small wire basket can then later be used to remove the fragmented stones.
   6. A plastic soft stent is required to be left after the operation for 1-4 weeks in the ureter.
5. Percutaneous cystolithotripsy - A minimally invasive procedure which is used to treat bladder calculi is called as percutaneous cystolithotripsy.

   How is percutaneous cystolithotripsy performed?

   1. The surgery is performed under general anesthesia
   2. Large Stones in the bladder are removed with this surgery
   3. A tract is created from the skin up to the bladder to gain the access to the stones
   4. Stones are generally fragmented with the use of a rigid nephroscope and laser or other devices and removed.
   5. Urethral catheters are placed after the completion of the surgery.