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.
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.
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- Fever
- 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.
- Sepsis
The recovery period following Retrograde Intrarenal Surgery (RIRS) can vary from person to person, depending on factors such as the size and location of the kidney stones and individual health. However, here’s a general timeline for recovery from RIRS:
After RIRS, patients typically spend a short time in the recovery area, usually a few hours, before being moved to a regular hospital room.
A urinary catheter is often placed to help with pain and discomfort and may remain for a day or more.
Bed rest is recommended for the first 24 hours to prevent infection, and patients are encouraged to drink plenty of fluids.
Days 2-7
During this period, patients are usually discharged from the hospital and can continue to rest at home. Pain and discomfort may persist but should gradually improve. Pain medication may be prescribed for relief.
Stitches or incisions may need care, and patients should follow any wound care instructions provided. Patients should avoid strenuous activities and heavy lifting during this time.
Weeks 2-6
Over the next few weeks, patients generally start to feel better and experience reduced pain and discomfort. Normal activities can be gradually resumed, but it’s important to listen to your body and avoid overexertion.
A follow-up visit with the doctor is essential to monitor the progress and ensure the procedure’s effectiveness.
Beyond 6 Weeks
Complete recovery usually takes several weeks to a couple of months, depending on individual factors. Some patients may experience minimal discomfort for an extended period, but it should gradually improve.
At the follow-up visit, imaging tests like an ultrasound or X-ray may be performed to check for any remaining stones or issues.
It’s essential to follow your healthcare provider’s instructions and recommendations regarding post-operative care, pain management, and activity levels. The exact duration of your recovery will depend on your unique circumstances, so be sure to communicate openly with your doctor regarding your progress and any concerns you may have.
What is Retrograde Intrarenal Surgery (RIRS), and when is it recommended for treating kidney stones?
RIRS is a minimally invasive surgical technique used to remove kidney stones. It is recommended under various conditions, including when traditional treatments like Shock Wave Lithotripsy or Percutaneous Nephrolithotomy are ineffective, for non-opaque stones that aren’t visible in x-rays, and in cases of multiple or large stones.
Before RIRS, a thorough evaluation is conducted, including physical examinations, blood tests, urine analysis, and imaging to precisely locate the kidney stone. In some cases, ureteral stents may be inserted, and fasting for at least six hours is necessary before the procedure.
RIRS is typically performed under general anesthesia to ensure patient comfort and relaxation. An endoscope is introduced through the urethra to access the stone. A specialized laser is used to break down the stone into fragments, which are then removed from the body.
After the surgery, a urinary catheter may be placed for a day or more to alleviate discomfort. Patients are advised to rest for 24 hours, drink plenty of fluids, and can gradually resume their normal routine as they recover. Follow-up sessions with the doctor may be necessary.
RIRS offers several advantages, including minimal invasiveness, shorter recovery times, and minimal bleeding. Risks are rare but may include fever, pain, urinary tract infection, and blood in the urine. The procedure is generally associated with a lower risk of kidney tissue damage and complications.