Risks, Complications and How to Reduce Them After RIRS

Medicine Made Simple Summary

RIRS is one of the safest and least invasive procedures for removing kidney stones, but like any surgery, it can have side effects or rare complications. This article explains the possible risks after RIRS — from mild discomfort to uncommon but serious issues — and how to minimize them. You’ll learn what’s normal, when to seek medical help, and what steps you can take before and after surgery to recover safely and confidently.

1. Understanding Risk: Why It’s Important to Know

RIRS (Retrograde Intrarenal Surgery) is considered very safe because it doesn’t require any cuts or incisions. The instruments are passed through natural urinary passages. Still, since it involves delicate organs like the kidney and ureter, mild irritation or temporary side effects can occur.

Knowing what to expect helps you stay calm, notice early warning signs, and take preventive steps for a smoother recovery.

2. Common and Mild Side Effects After RIRS

Most patients experience only minor symptoms for a few days after surgery. These are normal and not a sign of complications:

• Mild burning or discomfort when passing urine.
• Slight blood in the urine, especially after activity.
• Frequent urination or an urgent need to pee.
• Mild back or lower abdominal ache, especially if a stent is placed.

These symptoms usually improve within 3–5 days and can be managed easily with hydration, medication, and rest.

3. Temporary Discomfort Caused by the Ureteric Stent

If your doctor placed a stent after RIRS, you may notice some stent-related discomfort. This can include:

• A dull ache on the side where surgery was done.
• A feeling of fullness in the bladder.
• Burning during urination.
• Slight blood in urine.

While bothersome, these are short-lived. The stent ensures your kidney drains properly while healing, and symptoms resolve once it’s removed, usually within 1–2 weeks.

4. Minor Complications and How Common They Are

Minor complications after RIRS are relatively uncommon — they occur in about 5–10% of patients. These include:

• Urinary tract infection (UTI): The most frequent issue. Easily treated with antibiotics.
• Prolonged bleeding: Seen as blood in urine for more than a week. Usually clears with rest and increased hydration.
• Stent discomfort: Temporary, relieved after stent removal.
• Urinary retention: Difficulty urinating due to swelling, sometimes requiring short-term catheterization.

Your medical team will usually prescribe preventive antibiotics and pain medication to reduce these risks.

5. Rare but Serious Complications (Under 2–3%)

Serious complications after RIRS are extremely rare, especially when performed by skilled urologists using modern technology. However, awareness is key. Rare complications include:

• Infection spreading to the kidney (pyelonephritis): Causes fever, chills, and back pain. Needs prompt antibiotic treatment.
• Sepsis (systemic infection): Very uncommon but serious; requires hospitalization.
• Ureteral injury or perforation: A small tear may occur while passing instruments. Usually heals with a temporary stent.
• Residual stones: Small fragments may remain and cause future symptoms.
• Stricture formation (narrowing of ureter): Long-term rare effect, can be treated with minor corrective surgery.

Most of these can be prevented or managed successfully with timely care.

6. How Doctors Reduce Risk During RIRS

Your surgical team takes several steps to minimize risk during and after RIRS:

• Using sterile instruments and antibiotics to prevent infection.
• Controlling irrigation pressure to reduce swelling and bleeding.
• Placing a stent when necessary to allow smooth urine flow.
• Using low-energy lasers to prevent tissue damage.
• Performing thorough imaging to ensure all stones are removed.

Modern equipment and surgeon expertise play a huge role in keeping RIRS safe and effective.

7. How You Can Help Prevent Complications

You also play a vital role in your recovery. Follow these tips to lower your risk of infection, pain, or delayed healing:

• Take all prescribed medications — especially antibiotics — exactly as directed.
• Stay hydrated: Drink at least 2–3 liters of water daily to flush out bacteria and small fragments.
• Avoid strenuous activity for a week after surgery.
• Don’t skip follow-ups: Your doctor will check healing and stent position.
• Report symptoms early: Fever, heavy bleeding, or inability to urinate need attention right away.

8. Recognizing Warning Signs Early

Seek immediate medical help if you notice any of the following after RIRS:

• Fever above 101°F (38.3°C).
• Severe flank or back pain not relieved by medication.
• Heavy bleeding or blood clots in urine.
• Difficulty passing urine or no urine output.
• Persistent nausea, vomiting, or chills.

These are uncommon but serious signs of infection or blockage — early treatment ensures full recovery.

9. Infection Prevention: The Most Important Step

Urinary tract infections are the most common complication after RIRS, but they’re preventable. Here’s how to minimize the risk:

• Drink plenty of fluids to keep urine flowing.
• Avoid holding urine for long periods.
• Maintain good genital hygiene.
• Take the full course of antibiotics prescribed.
• Avoid public pools or baths until your doctor approves.

If you have diabetes or weakened immunity, inform your doctor, as you may need closer monitoring.

10. Managing Residual Stones

Sometimes, tiny fragments may remain after RIRS. Most pass naturally within a few days or weeks with hydration and mild activity.

Your doctor may schedule a follow-up ultrasound or CT scan after 2–4 weeks to confirm the kidney is clear. If small fragments remain, a second minor procedure or shock wave therapy (ESWL) may be done.

11. Long-Term Complications: Rare but Treatable

Long-term problems after RIRS are very uncommon but can include:

• Ureteral narrowing (stricture): Caused by scar tissue. Treated with dilation or stenting.
• Stone recurrence: Can happen if underlying causes (like low water intake or high salt diet) aren’t addressed.
• Chronic infection: Managed with lifestyle changes and medication.

Preventing these starts with good hydration, a balanced diet, and regular follow-up.

12. How Experience Reduces Complications

The surgeon’s expertise significantly affects the success and safety of RIRS. Experienced urologists use the latest flexible scopes and high-power lasers that reduce risk.

When choosing a center, ask:

• How many RIRS procedures are performed monthly?
• What’s the complication rate?
• Do they use digital flexible ureteroscopes?

A skilled team ensures minimal trauma, faster healing, and fewer complications.

13. Summary: Safe, Effective, and Low Risk

RIRS is among the safest kidney stone treatments, with very low complication rates compared to open or percutaneous surgery. Most side effects are temporary and mild.

The key to safety lies in:

• Proper preparation before surgery.
• Careful follow-up after.
• Open communication with your doctor.

When performed in experienced hands, RIRS offers high success, fast recovery, and long-term comfort.

Conclusion

If you’ve recently undergone RIRS or are planning to, discuss potential risks and how to prevent them with your urologist. Follow your medication and hydration plan, attend follow-up visits, and never ignore new symptoms. A little care goes a long way toward ensuring your recovery stays smooth and complication-free.