What is RIRS? A Simple Guide to the Procedure and When it is Used

Medicine Made Simple Summary

If you’ve been told you might need Retrograde Intrarenal Surgery (RIRS), don’t worry — this guide will walk you through it in plain language. RIRS is a modern, minimally invasive method to remove stones from the kidney by using a thin flexible scope passed through your urinary tract. You’ll learn why and when it’s used, how the procedure works, what happens before and after, the benefits and risks, and how to prepare and recover. This article is aimed at people without medical training, so you and your family can understand exactly what’s involved.

1. What is RIRS?

The term RIRS stands for Retrograde Intrarenal Surgery. “Retrograde” means going in the opposite (backward) direction of the normal flow—so the instrument is inserted through the urinary tract and up into the kidney. “Intrarenal” means inside the kidney. In short, RIRS is a procedure that allows a surgeon to reach inside your kidney using a flexible scope, break up stones (if they are present), and remove or enable them to pass.

Over recent years advances in flexible ureteroscopes, lasers and accessory tools have made RIRS a safe and effective option for many kidney-stone cases. 

2. Why do kidney stones need treatment?

Kidney stones are solid lumps made of minerals and salts that form inside your kidneys. While small stones might pass on their own, larger ones or those in awkward locations can cause:

• severe pain (often called “renal colic”),

• blood in the urine,

• infection,

• damage to kidney tissue or function.

When a stone is unlikely to pass naturally, is causing symptoms, or is located in a place where it could cause problems, your doctor may recommend treatment. That treatment could be medical (medications, increased fluid) or procedural (like RIRS).

3. When is RIRS used? The Indications

Knowing when RIRS is a good choice helps you understand why your doctor might suggest it. Some common situations include:

• Kidney stones up to about 1-2 cm in size that are not easily treated by non-surgical means. 

• Stones that have failed to respond to other treatments such as shock-wave lithotripsy.

• Stones located in parts of the kidney that are hard to reach by simpler treatments.

• Patients for whom a less invasive procedure is preferable (for example due to other health issues or anatomy).

• In selected cases even larger stones (2-3 cm) where surgeon expertise allows, though this may require more sessions. 

Important: RIRS is not always the best choice for every stone. Very large stones (for example >2-3 cm), certain complex stone burdens, or very hard stone types may be better treated by other methods.

4. Understanding the Alternatives

Before RIRS was widely available, other treatments included:

• Extracorporeal Shock Wave Lithotripsy (ESWL): Uses shock waves from outside the body to break stones. Less invasive but may not work for large or awkwardly-placed stones.

• Percutaneous Nephrolithotomy (PCNL): A small incision is made in the back and a tube is passed directly into the kidney to remove stones. More invasive but effective for large stones.

• Ureteroscopy (URS): A rigid or semi-rigid scope passed through the urinary tract to remove or break stones in the ureter or lower kidney.

RIRS sits between these options: more invasive than ESWL but less so than PCNL. It offers good balance in many cases. Guidelines from the European Association of Urology (EAU) and related literature note it as a standard treatment for suitable stones.

5. How is the RIRS Procedure Performed?

Here’s a simplified breakdown of what happens. Your surgeon and team will cover specifics based on your hospital and condition:

5.1 Pre-operative preparation

You’ll have imaging tests (CT scan, ultrasound) to determine size, location, number of stones. Blood and urine tests check infection or bleeding risk. Your doctor will explain any medicines you should stop (e.g., blood thinners). You may be asked not to eat or drink for several hours before surgery.

5.2 Anesthesia and setup

RIRS is usually done under general anesthesia (you’re asleep) though sometimes spinal sedation is used based on patient factors. You will be on a bed in the “lithotomy” position (legs elevated) or slightly modified.

5.3 Accessing the kidney

The surgeon inserts a thin flexible ureteroscope through your urethra, then bladder, then up your ureter into the kidney. A guide-wire, sheath (access tube) may help move the scope safely. Fluoroscopic/X-ray guidance ensures correct placement. 

5.4 Locating and dealing with the stone

Once inside the renal collecting system (where urine drains inside the kidney), the surgeon finds the stone. A laser fiber is passed through the scope and used to break the stone into small fragments (laser lithotripsy). These fragments may then be removed using baskets or flushed out.

5.5 Finishing up

After stone removal, a small stent (a thin tube) may be left in your ureter to help drainage and healing. The scope is removed carefully. The procedure time varies (45-90 minutes) depending on stone size and complexity.

5.6 Post-operative monitoring

You’ll go to recovery and monitored for urinary flow, bleeding, pain, infection. Many patients are discharged the same day or after one night stay depending on hospital policy.

6. What to Expect During Recovery

Because RIRS is minimally invasive, the recovery tends to be quicker than older open surgeries. However, you should know what to expect:

• Mild discomfort, urinary frequency, or a burning feeling when urinating are common in first days.

• Blood in the urine may persist for a few days — usually resolves.

• If a stent is placed, you may feel some “foreign body” sensation, need to urinate more frequently, or have mild flank/ureteric pain.

• You will be advised to hydrate well (drink water) so that any residual fragments flush out.

• Avoid heavy lifting, strenuous exercise for at least 1-2 weeks (or as advised).

• Follow-up imaging may be scheduled to check for residual stones.

In many cases you can return to work or normal daily activities within a week or two. The exact timeline depends on stone size, how the surgery went, your general health.

7. Benefits of RIRS

Why choose RIRS? Some advantages:

• It uses your natural urinary tract, so no large incision in your back or flank.

• Shorter hospital stay, quicker recovery versus more invasive surgery.

• Lower risk of some complications (bleeding, wound infection) than open surgery.

• Ability to reach stones in otherwise difficult positions inside the kidney (due to flexible scope).

• Technological improvements mean better stone-free outcomes for many patients.

8. Risks and Limitations

No procedure is entirely without risk, and RIRS has limits:

• It may not remove all stone fragments in one go — sometimes small pieces remain, requiring follow-up.

• Some stones (very large size, very hard composition, unusual anatomy) may not be ideal for RIRS. In those cases, other procedures like PCNL may work better. 

• Possible complications include: infection, bleeding, injury to the ureter or kidney, tissue damage, need for additional procedures. 

• The cost and availability of technology and surgeon experience can vary.

• While recovery is faster than open surgery, you still need to follow post-operative instructions closely.

9. How to Know if You’re a Good Candidate?

If you or a family member are considering RIRS, ask your doctor these questions:

• What is the size, number and location of my stone(s)?

• Are there features (anatomy, prior surgeries, infections) that may make RIRS more or less effective?

• What are the specific success chances in my case (stone-free rate)?

• What are the expected risks and how do they compare to other options?

• What will recovery look like for me? How soon can I get back to work, normal life?

• Who will perform the procedure and what is their experience with RIRS?

• What happens if some fragments remain? Will I need a second session?

10. Questions to Ask Pre-Procedure & How to Prepare

• Ensure you have a full explanation of the procedure, what to expect, and alternatives.

• Ask about pre-operative tests: imaging, bloodwork, urine culture (infection check).

• Let your doctor know about any medications you take (especially blood thinners) or conditions like bleeding disorders.

• Arrange for transport home after the procedure and someone to stay with you if needed.

• Plan your recovery: time off work, limiting heavy activity, hydration, follow-up visits.

• Ask about the likely hospital stay, pain management, stent removal plan.

11. After the Procedure: Recovery & Long-Term Care

• Follow all discharge instructions: medications (pain relief, antibiotics if needed), when to resume activity.

• Drink plenty of water — this helps flush any tiny fragments and prevents formation of new stones.

• Follow up imaging (ultrasound, CT scan) as your doctor recommends to ensure no remnants remain.

• Consider lifestyle changes: diet modifications, weight management, avoiding stone-promoting foods (depending on stone type).

• Monitor for any signs of complication: fever, persistent or worsening pain, heavy bleeding, difficulty urinating — contact your doctor if these occur.

12. Realistic Outcomes and What to Expect Going Forward

Many patients treated with RIRS achieve good outcomes: complete or nearly complete removal of the stones, relief of symptoms, and return to normal activities. The “stone-free rate” (percentage of patients without residual fragments) varies depending on stone size and complexity but is high in suitable cases. 

If some fragments remain, they may pass on their own or might require another procedure. It’s important to remember that kidney stones can recur — your doctor will guide you on preventive measures.

13. What You Need to Know

RIRS is a modern, minimally invasive option for treating kidney stones. It offers a way to reach stones via the urinary tract, break them using a laser, and remove or allow them to pass, often with shorter recovery and fewer complications than older surgeries. It’s not suitable for every case, so the decision depends on stone size, location, patient anatomy and health. Being well-informed, asking the right questions and following pre- and post-procedure guidance will help you get the best outcome.

Conclusion

If you’ve been diagnosed with kidney stones and a doctor has mentioned RIRS as an option, take the next step by scheduling a consultation. Ask for a detailed assessment of your stone size, location and the surgeon’s experience with RIRS. Prepare your questions in advance, arrange support for the post-procedure period, and make sure you understand what recovery will look like. Remember, being informed helps you and your family make the best decisions for your health.