Retrograde intra renal surgery (RIRS): the most minimally invasive stone surgery, its safety and efficacy in patient with sickle cell anemia. A case report and review of literature for the optimal peri-operative management in sickle cell patients

Abstract

Sickle cell anemia (SCA) is a genetic hematologic disorder characterized by repeated hemolytic and vaso occlusive episodes. Surgical procedures in such patients carry the risk of bleeding and coagulation problems. Kidney stone is a common health problem in India. Optimal management depends on various stone-related factors (stone burden, location, hardness, degree of hydronephrosis) and patient-related factors. Kidney stone surgery in patients with bleeding disorders can be challenging. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are minimally invasive procedures. However, they carry a risk of bleeding and are relatively contraindicated in patients with bleeding disorders. Retrograde intra renal surgery (RIRS) is the most minimally invasive modality for upper tract calculi due to the lowest risk of bleeding. Since there is no puncture of the kidney, it is relatively safe in patients with bleeding disorders, cardiac patients on antiplatelet therapy, recurrent stone formers, solitary kidneys, and stones in anatomically abnormal kidneys. Our patient presented with a 13 × 12 mm upper ureteral calculus with hydronephrosis. He was diagnosed with SCA during pre-operative work up. We achieved complete stone clearance with RIRS. No postoperative complications such as bleeding, urosepsis, sickling crisis, renal infarction, etc. were observed. The patient was discharged within 48 hours and is doing well. To date, there is no reported case of RIRS for renal stone management in patients with SCA. We aim to report this case and review the literature for the ideal perioperative management of SCA patients.

Keywords: Sickle cell disease, sickle cell anemia, retrograde intra renal surgery, kidney stone, percutaneous lithotomy, extra corporeal shock wave lithotripsy