A fibre-optic endoscope is used to perform the procedure. The tube that has a camera and light source at one end. This tube is inserted through an opening called the urethra that provides access to the kidneys where the stone has been located through preoperative diagnostic methods.

A special laser fibre probe known as the “Holmium: YAG Laser” is used to break the stone into small fragments. These fragments are then removed using special instruments.

This procedure is used as the choice of treatment under the following conditions:

• Urinary stones that cannot be treated or have failed to be treated with other procedures like Shock Wave Lithotripsy or Percutaneous Nephrolithotripsy
• Non-opaque stones that are not visible in traditional x-rays.
• When your urologist determines the existence of anatomic abnormalities
• When renal and ureteral stones are present at the same time
• Bilateral kidney stones where can be removed in the same session
• Multiple kidney stones were found at various locations
• Bleeding disorders in the patient
• If your occupation determines kidney stones as not fit to perform
• If you are obese or with musculoskeletal deformities.
• Stones that are larger than 3 cm and need removal
• In children, with kidney stones where a less aggressive approach is preferred.

Conditions Treated with RIRS

RIRS, i.e., Retrograde Intrarenal surgery, is a surgical procedure that involves kidney stone removal by entering the kidney through the ureter, i.e. in a retrograde or reverse manner. RiRS kidney stone treatment will be required if a patient has problems urinating and has kidney stones in the kidneys or urinary tract. The technique is best for those with stones between 10mm and 14mm and when the ureteroscopy and lithotripsy fail. There are many conditions treated with RIRS : 

• Kidney stone 

The RIRS is used to treat kidney stones smaller than 2 cm and is very effective for kidney stones located in challenging regions of the kidney that cannot be reached with other surgical techniques. 

• Tumors and lesions 

RIRS is also used for biopsy or ablate tumours and lesions in the kidney. It is a versatile surgical procedure that is minimally invasive in diagnosing and treating many kidney conditions and offers precise targeting and management of issues without invasive surgery. 

• Other urological disorders 

RIRS addresses other urological conditions that also need precise and minimally invasive intervention. It helps treat structures that narrow the urinary tract and correct anatomical abnormalities. 

RIRS is generally performed for the removal of kidney stones and is recommended in situations where other surgical approaches may not be effective. RIRS is to treat complex stone formation in patients with certain medical conditions like bleeding disorders or with failed procedures.

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How is Retrograde Intrarenal Surgery (RIRS) performed?

• General anaesthesia is usually preferred as the patient may be subjected to pain and trauma due to inadequate relaxation of the ureters or uninhibited breathing.
• After making sure that the patient has gone under anaesthesia, the urologist will introduce an endoscope- a thin, flexible tube through the urethra or the urinary opening.
• This endoscope is advanced through the urethra and beyond the bladder.
• During this procedure, the endoscope will detect urinary stones along the path.
• A special type of laser is used to destroy the stone by breaking it down into fragments.
• The broken fragments are collected using a specialized basketing instrument and then eliminated from the body.
• “Dusting” is the process where laser energy is used to reduce the stone to fine particles and fragments that are lesser than 2 mm in diameter, which will later get eliminated through the urine.

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Advantages of RIRS Surgery

RIRS surgery is versatile and effective in treating kidney stones of multiple sizes and locations, whether small or large. Stones. It offers a reliable treatment solution that can be tailored according to the patient’s requirements. RIRS kidney stone treatment offers many advantages compared to traditional surgical methods used to treat kidney stones. The benefits of RIRS are: 

• It is minimally invasive.

RIRS is a minimally invasive technique and an effective scarless procedure that does not involve incision. The method uses a flexible ureteroscope that allows the surgeon to access the kidney through the urinary tract, which makes it less traumatic for the patient and offers fast recovery.

• Reduced complications 

RIRS surgery lowers complications like infection, bleeding, and post-surgical pain. The surgery option is best for people with health conditions like bleeding disorders, cardiovascular disease, and diabetes. 

• Short recovery phase

The surgery is minimally invasive and thus leads to faster recovery as compared to open surgery. 

• High success rates 

RIRS has high success rates of about 85 to 90 percent, making it the most effective technique to remove kidney stones.

• Suitable for high-risk patients

RIRS is suitable for all, including high-risk patients with obesity, advanced age, and other medical conditions.

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Preparation for RIRS Surgery

RIRS surgery is performed after a detailed patient history assessment, physical examination, and imaging studies. To get well prepared for RIRS surgery, patients must :

Discuss all the details of the RIRS procedure with your surgeon, including the pros and cons. 

Patients should get all blood or imaging tests that are needed to be done before the surgery.

Follow your surgeon’s advice properly regarding what to take, what to eat, and how much to do. 

Also, discuss any allergies or health issues you have with your surgeon. 

Imaging tests are done to get the exact location of the kidney stones. 

In some cases, preoperative ureteral stents may be inserted before the procedure.

There is a need for about six hours of fasting before RIRS. 

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Procedure Overview

General anesthesia is given to the patient to avoid any pain and trauma during the procedure.

1. The RIRS surgery procedure starts with a small incision in a patient’s back, through which the flexible tube ureterorenoscopy is inserted for guidance into the patient’s kidney.
2. After the stone location is detected the surgeon uses small instruments passed through the tube to fragment the stone into smaller pieces so that these can be easily removed or passed through the urinary tract.
3. The broken pieces are then collected using a specialized basketing instrument and removed from the body. 
4. After that, dusting is done, the procedure where laser energy is used to reduce the stone to fine particles that are about 2 mm and can be removed through the urine effectively. 
5. The patient may experience some pain and discomfort post-RIRS that can be managed well with pain medication.
6. Patients can return to normal routine within a few days after the RIRS procedure. 

Postoperative Care

RIRS surgery recovery time is crucial as patients must follow the surgeon’s advice post-surgery and the tips to recover fast. Patients are kept under observation for some time immediately post-RIRS. After that, they are allowed to go back home. . After a day following the surgery, the patient should drink plenty of water to help flush out any residual stone fragments. It is also advanced to avoid strenuous activity for about a week to recover well. If in case a stent is placed, it will need to be removed within a week or two after RIRS surgery, depending on the surgeon’s recommendation. After the procedure, patients might feel discomfort and pain or a burning sensation during urination for some days; however, it will be resolved independently. 

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Risks and Complications

RIRS is considered a safe procedure. However, RIRS surgery side effects and complications are rare but can be seen in a few cases. The risks and complications that can be there include: 

• Flank pain
• Urinary infection
• Fever
• Acute urinary retention
• Blood in urine
• Narrowing of ureter 
• Sepsis

Preventing Kidney Stones Post-Surgery

After successful kidney stone surgery in Delhi, the surgeon will advise you to take proper care to prevent these stones post-surgery. Diet and lifestyle changes play a vital role in preventing kidney stone formation in the future. Tips to keep in mind are:

• Staying hydrated is a must after RIRS surgery, as dehydration is one of the foremost causes of kidney stones. Drinking about eight glasses of water can help flush out kidneys and prevent stone formation.
• Reducing sodium intake is necessary as it can increase the risk of developing kidney stones. You must avoid eating foods high in sodium like fast foods, processed foods, canned goods, etc., and consume fresh fruits and veggies with whole grains and lean protein. 
• Increasing calcium intake can prevent kidney stone formation as calcium binds to oxalate in the digestive tract. Foods rich in calcium are dairy products, almonds, and leafy greens. 
• Avoid having a diet rich in animal protein, as it can increase urine uric acid, which leads to stone formation. Plant-based protein, like nuts, legumes, and whole grains, should be used instead.
• Maintain a healthy weight, as obesity increases your chances of developing kidney stones. Maintaining proper health with regular exercise will help you stay fit and active. 

Conclusion

RIRS surgery in Urology is the most advanced technique to remove kidney stones without invasive techniques. It is a minimally invasive procedure with high success rates, fast recovery, minimal side effects, and complications. RIRS is counted among the preferred options for patients worldwide as it is an effective option whether you are struggling with complex kidney stones or renal issues. Consult Handa Nursing Home, one of the best clinics in Delhi, for kidney stone removal. The clinic specializes in RIRS kidney stone treatment and ensures precision in removing renal stones. RIRS is the most effective procedure for kidney stones deep within the renal anatomy. Consulting with an experienced doctor at Handa Nursing Home who has experience with RIRS is essential to determining the best treatment plan.