RIRS (Retrograde Intrarenal Surgery)

Retrograde Intrarenal Surgery

What is RIRS:

RIRS (Retrograde Intrarenal Surgery) is an endoscopic surgery performed to remove renal stones by reaching the kidney from the ureter. RIRS procedure is performed with fibre optic or Digital endoscope and stone is fragmented with a laser fibre either Holmium or Thulium fibre – to treat the kidney stones.

How the procedure performed?

The surgery is performed by a urologist who has specialized expertise in RIRS. During the procedure, the patient is given spinal or general anesthesia and the endoscope is inserted in the body through the urethra then into the kidney; the surgery does not involve any incisions and hence, has a very fast recovery time. Once the large stone is removed, small fragments of the stones are taken off through stone baskets.

In some cases, a double J stent is placed inside urinary tract to passively dilate ureter (the tube below kidney )10 days before RIRS surgery.

With RIRS a vast majority of renal stones can be cleared without open surgery. Moreover, with the recent technological developments in the management of renal stones, RIRS has emerged as a very reliable, safe and efficient method. The main purpose of a renal stone treatment is to clear the stones completely with minimum morbidity – RIRS clears renal stones through flexible ureterorenoscopy and lithotripters including holmium laser, ensuring no trace of stones are left. Moreover, advancement in related equipment’s such as guide-wires, ureteral access sheath and stone baskets have enhanced the effectiveness of the RIRS procedure. As of today, RIRS is a prime method of treatment for renal stones that are less than 2 cm and cannot be successfully treated via other methods.

A RIRS procedure is particularly useful in patients where:

  • Earlier attempts to remove renal stones have failed
  • Stones are large in size for ESWL.
  • There is a tumour in the kidney
  • The patient involved is a child
  • The patient has bleeding disorders
  • The patient is obese
  • The patient has complex anatomical kidneys
  • Patient is on anticoagulants

Procedure of the RIRS 

A retrograde intrarenal surgery is simple, less invasive and has fewer chances of any complications.

  • Before the Surgery: 
  1. X ray KUB/Plain CT KUB
  2. Preoperative blood tests.
  3. Pre op fitness from anaesthesist
  4. Pre-operative DJ stenting 2 weeks before to the actual procedure if needed in few cases; this stenting makes it easier for the ureteroscope to enter the kidneys easily since ureter is already dilated.
  5. Empty stomach for 6 to 8 hours.
  • During the Surgery:

The patient will be under anesthesia either general or regional anaethesia , and the urologist will use an fibre optic or digital endoscope – a thin, flexible tube – to reach the bladder through the urethra and then further to the area of urine storage in the kidney. During this process, the endoscope will identify stones and blast them with a laser till golden sand is formed. Further, the Dj stenting done two weeks’ prior helps to smoothen and fasten the recovery time; in most cases, patients are discharged on the next day post-surgery.

  • After the Surgery:Post completion of the surgery, a urine catheter is placed in the urethra to reduce pain and problem while urinating; the catheter is placed for 8 to 24 hours . The patient is then put in a recovery room and a 24-hour rest is advised. Further, the patient needs to drink a lot of fluids at least 3 litres every day; this helps to keep infections away. Also, in case the patient is healthy and absolutely fit to resume everyday activities, he/she can be discharged right the next day of the surgery. However, a follow-up with the doctor is important.

Advantages of the Surgery:

Retrograde intrarenal surgery is one of the novel methods to treat renal stones. Some of the advantages of the RIRS method are:

  • Minimally invasive
  • Simple and quicker procedure
  • Shorter recovery time
  • Less painful
  • Less morbidity
  • Minimal bleeding
  • No risk to the renal tissue
  • Fewer complications

Risks of the Surgery :

Complications or risks associated with RIRS are fairly uncommon and occur only in very few cases.

  • Fever
  • Flank pain
  • Urinary infection
  • Transient hematuria
  • Acute urinary retention
  • Fornix rupture
  • Ureter avulsion
  • Bleeding
  • Sepsis

For kidney stones more than 2 cm ( high stone burden) RIRS is not preferred and in such patients minipark is good choice of treatment.

Overall RIRS is an effective, feasible and minimally invasive treatment for renal stones with high success rates and lower complications.