A CT scan at Tam Anh General Hospital, TP HCM, revealed a 12 mm right kidney stone in Ninh's lower calyx, which had not yet caused hydronephrosis. Dr. Nguyen Tan Cuong, Deputy Head of Urology and Head of the Urological Oncology Unit at the Urology - Nephrology - Andrology Center, Tam Anh General Hospital, TP HCM, prescribed flexible ureteroscopic lithotripsy (RIRS), opting against a ureteral sheath during the procedure.

The medical team performed flexible ureteroscopy to remove stones via the natural urinary tract for Ninh. Photo: Tam Anh General Hospital

Dr. Cuong explained that a ureteral sheath helps guide instruments to the kidney and creates an outflow for irrigation fluid. However, if a patient's ureter is suitable, not narrow, and allows safe passage of the flexible scope, doctors may choose not to use this device. This approach avoids potential ureteral damage from sheath placement, especially in patients who have not had a ureteral stent previously, and reduces costs.

Doctors must carefully manage irrigation flow and pressure within the renal collecting system throughout the procedure to minimize complications from elevated pressure. Currently, this technique treats stones smaller than 2 cm, a shift from previous practices where a ureteral sheath was used for all cases.

Guided by a C-arm system, which provides high-resolution, real-time X-ray images, Dr. Cuong precisely controlled the flexible scope. He located stones in hard-to-reach areas, such as the lower renal calyx, while protecting surrounding healthy tissue. This retrograde lithotripsy method, performed via the natural urinary tract, avoids incisions, minimizes invasiveness, and reduces patient pain. Upon reaching the stone in the lower calyx, Dr. Cuong used laser energy to fragment it into small pieces, which were then extracted with specialized instruments.

Ninh was alert, able to walk, eat, and perform light activities 12 hours after the procedure, and discharged within 24 hours. Dr. Cuong explained that because the flexible ureteroscopy involves no incision and accesses stones through the natural urinary tract, patients recover quickly. This is a significant improvement over percutaneous nephrolithotomy, which typically requires 2-3 days of hospitalization, or traditional open surgery, which necessitates 5-7 days. Patients are advised to drink 2-2,5 liters of water daily to help pass any remaining small stone fragments and to attend follow-up appointments for a complete evaluation of their urinary system.

Urinary stones are a common condition in Vietnam, affecting an estimated 2-12% of the population, with kidney stones accounting for 40% of cases. The condition often progresses silently, with symptoms such as renal colic, flank pain, hematuria, or dysuria only appearing when stones grow, move into the ureter, or cause obstruction. The most dangerous complication is infection, which can impair kidney function.

Dr. Cuong warned that stones tend to recur if risk factors like low water intake, a diet high in salt and animal protein, or metabolic disorders are not well-managed. Individuals with a history of kidney stones should proactively adjust their lifestyle and attend regular check-ups for early detection of abnormalities and timely intervention.

Ha Thanh

*Patient's name has been changed