Retrograde Intra Renal Surgery or RIRS is the latest urology technique used for the removal of kidney stones. It is a safe and minimally invasive method to remove renal stones with precision.
RIRS is a procedure that involves the removal of kidney stones by entering the kidney in a reverse or retrograde manner- through the ureter. It involves the use of a fibre-optic endoscope and special laser known as the Holmium laser.
What is Retrograde Intrarenal Surgery (RIRS)?
Retrograde Intrarenal Surgery or RIRS is a new surgical technique that is used to remove kidney stones in a retrograde fashion and is performed under spinal or general anaesthesia.
- 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.
What are the prerequisites for Retrograde Intrarenal Surgery (RIRS)?
- A complete assessment through physical examination, blood tests, urine analysis etc
- Antibiotics may be prescribed by the doctor when an infection is detected.
- Imaging techniques that pinpoint to determine the location of the kidney stone.
- In some cases, pre-operative ureteral stents may be inserted before the procedure to facilitate access to the stone. This is done by dilating the ureter.
- In children, passive dilatation before the scope enters provides the surgeon with better access in cases of anatomical abnormalities.
- A six-hour fast is mandatory before the procedure
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.
What are the post-operative instructions to be followed after the RIRS?
- After the surgery is completed, a urinary catheter will be placed for a day or more in the urethra to help with pain and discomfort.
- Complete bed rest for 24 hours and plenty of fluid intake are advised to prevent infections.
- The patient will be able to resume their routine in the next few days, as they start feeling healthy.
- A follow-up session with the doctor is important to monitor the effect of the procedure.
- Sometimes, stenting is done following the surgery in those with an increased risk of complications.
- This includes trauma to the urethra or perforation, residual fragments from the dusting, pregnancy, severe urinary tract infection, and bleeding.
What are the advantages of Retrograde Intra Renal Surgery (RIRS)?
- The procedure is minimally invasive
- It is a simpler and quicker procedure as compared to other treatments
- RIRS has a shorter recovery time.
- The procedure is painless.
- The procedure is associated with minimal bleeding.
- There are fewer risks of damage to the kidney tissue and other complications.
- The need for hospital stay is not more than one day
- Both kidneys can be treated together at the same time
What are the risks associated with Retrograde Intrarenal Surgery (RIRS)?The risks with RIRS are very rare and occur only in very few cases and may include
- Pain in the flanks and includes pain in the upper abdomen, sides or the back
- Urinary tract infection (UTI).
- Blood in the urine.
- Inability or difficulty to urinate.
- Narrowing of the ureter and avulsion.