Retrograde Intrarenal Surgery (RIRS)

As a common urological condition, kidney stones can lead to intense discomfort, chronic infections, and impaired urinary flow. Although minor stones often exit the body naturally, medical intervention is essential for larger deposits that cause persistent pain or are resistant to medication. 

Retrograde Intrarenal Surgery (RIRS) provides a minimally invasive solution, removing stones through the urinary tract without incisions. Specialists use advanced endoscopes to locate and extract stones from the kidney. RIRS is typically advised when other treatment modalities are deemed unsuitable. Performed by expert urologists in a hospital setting, this procedure adheres to strict clinical protocols. It ensures a high level of accuracy in stone clearance while avoiding the complications of open surgery. 

RIRS is an advanced endoscopic surgery specifically developed to eliminate stones located within the renal system. The term "retrograde" refers to the instrument entering through the urethra and moving through the urinary tract, avoiding external incisions. A thin, flexible ureteroscope is guided into the kidney, where a holmium laser fragments the stones. These fragments are either removed using retrieval baskets or allowed to pass naturally through urine.

Avoiding external incisions allows RIRS to offer a quicker recovery period than traditional surgical procedures. This procedure allows for direct renal access with minimal trauma. Conducted by skilled specialists, RIRS improves patient comfort and enables a rapid return to health using advanced technology.

RIRS is typically suggested when medication is ineffective for kidney stones or when non-invasive treatments are unlikely to achieve success. Determining factors include stone size, position, patient health, and previous clinical responses.

Doctors may recommend RIRS in the following situations:

• Renal stones under 2 cm located in difficult-to-reach internal areas

• Stones that have not responded to extracorporeal shock wave lithotripsy

• Recurrent calculi causing significant pain or frequent urological infections

• Individuals who are not suitable for more invasive percutaneous surgery

• Staged management of stones present in both the left and right kidneys

• Persistent kidney obstruction or swelling resulting from a confirmed stone

• Patients with a documented preference for minimally invasive surgical care

RIRS is highly effective for stones in the lower part of the kidney, an area where other treatments may provide inadequate results.

RIRS is not required for all patients; small kidney stones often pass naturally through hydration. A urologist will select the correct procedure after a professional clinical assessment.

Common candidates for the RIRS procedure include:

• Patients with moderate-sized stones requiring removal

• Individuals dealing with recurrent pain caused by stones

• Those for whom shock wave therapy has been unsuccessful

• Patients with anatomical issues that hinder other surgical techniques

• Individuals with bleeding risks for whom invasive surgery is less safe

The urologist reviews diagnostic imaging, such as CT scans or ultrasound, to confirm that RIRS is the most suitable treatment option.

Although RIRS is minimally invasive, specific conditions make it inappropriate. Doctors typically avoid the procedure for patients who:

• Have active urinary tract infections

• Have untreated bleeding disorders

• Have very large stones that may require alternative procedures such as percutaneous nephrolithotomy (PCNL)

• Are medically unstable for anaesthesia

In such cases, the patient’s condition is first stabilised, or a different treatment approach may be recommended.

Qualified urologists perform RIRS under spinal or general anaesthesia. The procedure takes place in a dedicated operating theatre with laser and endoscopic support.

Before the Procedure

The surgeon reviews the clinical indications for RIRS and available alternatives. Patients are invited to discuss the benefits and potential risks of the surgery.

Preparation consists of:

• Blood and urine diagnostic tests

• Imaging to map stone size and renal location

• Fasting for several hours pre-operatively

• Disclosing the use of blood thinners or chronic meds

If a urinary infection is found, it is treated before the patient undergoes the RIRS procedure.

During the Procedure

Following the onset of anaesthesia, a flexible ureteroscope is navigated through the urethra and into the kidney. Laser lithotripsy is used to break the stone into small fragments. These are either retrieved using baskets or left to pass. In many instances, a temporary ureteral stent is inserted to aid urine passage and reduce renal swelling. The procedure takes between 45 and 90 minutes.

After Retrograde Intrarenal Surgery

Patients are observed for several hours. Discharge is typically the same day. Common effects include:

• Mild burning during urination

• Blood in the urine (for several days)

• Mild flank pain

• Increased frequency (stent-related)

Symptoms subside over time. Stents are removed after a short period. Patients must drink plenty of fluids and follow medication guidelines.

In clinical practice, RIRS is highly effective, though it is not without minor risks.

Possible risks include:

• Persistent fever

• Urinary infection

• Temporary blood in the urine

• Rare injury to the ureter

• Localised stent discomfort

While rare, retained fragments can occur and sometimes require secondary measures. Close clinical observation during the recovery period ensures these risks are handled with professional care.

There are several advantages of RIRS over traditional surgical interventions:

• Zero external incisions

• Extremely low blood loss

• Shortened hospitalisation periods

• Improved recovery speed

• Minimalised postoperative pain levels

• High suitability for patients with bleeding risks

At Gleneagles Hospitals, Retrograde Intrarenal Surgery (RIRS) is performed by experienced urologists trained in advanced minimally invasive stone management. The hospital combines specialised expertise with modern technology to ensure safe and effective treatment.

Key features include:

• Advanced flexible ureteroscopes for precise access to kidney stones

• Modern laser lithotripsy systems for accurate stone fragmentation

• Dedicated endourology operating theatres with continuous monitoring

• Comprehensive preoperative evaluation, including imaging and laboratory tests

• Anaesthesia and specialised nursing support throughout the procedure

• Postoperative observation, pain management, and short-stay recovery care

• Stone analysis and metabolic evaluation to help prevent recurrence

Each patient receives personalised treatment planning and structured follow-up consultations. At Gleneagles Hospitals, RIRS is recommended based on careful clinical assessment, ensuring that patients receive the most appropriate and effective care for their condition.

Retrograde Intrarenal Surgery (RIRS) provides a streamlined, incision-free solution for removing kidney stones. By accessing the renal system through natural pathways, it facilitates a quicker recovery and reduces the physical impact on the patient. Suitability for the procedure must be confirmed by a urologist through a formal assessment. When implemented with advanced surgical skills and diligent follow-up, RIRS is an exceptionally effective treatment. It offers a reliable path to stone-free status, significantly enhancing patient comfort and ensuring the efficient management of renal health through modern, minimally invasive techniques.