What Is RIRS?

RIRS stands for Retrograde Intrarenal Surgery. It is a minimally invasive procedure that allows a urologist to access the inside of the kidney through the natural urinary tract.

During RIRS, a flexible ureteroscope is introduced through the urethra and bladder and then advanced through the ureter into the kidney. The stone is identified using the camera on the scope and may be fragmented using an appropriate energy device. The stone fragments can then be removed or allowed to pass naturally depending on their size and the clinical situation.

Who May Need RIRS?

RIRS may be considered for patients with kidney or upper urinary tract stones when endoscopic treatment is appropriate.

• Small to medium-sized kidney stones that are suitable for flexible ureteroscopic treatment.
• Stones located in parts of the kidney that may be difficult to treat with shock wave lithotripsy.
• Kidney stones that have not responded adequately to previous treatment.
• Patients for whom a minimally invasive endoscopic approach is considered appropriate.
• Selected renal stones where RIRS may provide a suitable alternative to other stone-treatment procedures.

Symptoms of Kidney Stones

Kidney stones may sometimes be found incidentally without causing symptoms. When symptoms occur, they may include:

• Sharp pain in the side, back, lower abdomen or groin.
• Pain that may occur in waves.
• Blood in the urine.
• Pain or burning during urination.
• Frequent or urgent urination.
• Nausea or vomiting.
• Cloudy or foul-smelling urine, particularly when a urinary infection is present.

Causes of Kidney Stones

Kidney stones develop when minerals and other substances in urine become concentrated and form crystals. Different types of stones can form depending on the substances involved.

Low fluid intake, dietary factors, metabolic abnormalities, certain medical conditions, urinary infections and a personal or family history of stones can contribute to stone formation.

Risk Factors for Kidney Stones

• Previous kidney stones.
• Family history of kidney stones.
• Low daily fluid intake.
• Dietary patterns associated with increased stone-forming substances in the urine.
• Certain metabolic or endocrine conditions.
• Some urinary tract infections.
• Obesity and associated metabolic factors.

Types of Kidney Stones

Kidney stones can be classified according to their chemical composition. Common types include:

How Is a Kidney Stone Diagnosed?

Diagnosis generally involves a medical history, physical examination, laboratory investigations and appropriate imaging. The exact tests depend on the patient's symptoms and clinical circumstances.

Common Diagnostic Tests

• Urinalysis and urine examination.
• Blood tests to assess kidney function and relevant metabolic factors.
• Ultrasound of the kidneys and urinary tract.
• X-ray in selected cases.
• Non-contrast CT scan when appropriate to assess stone size, location and urinary obstruction.
• Stone analysis when a stone or fragment is available.

Imaging helps the urologist understand the size and location of the stone, kidney anatomy and whether RIRS or another treatment approach may be suitable.

When Should You See a Urologist?

You should consider consulting a urologist if you have recurrent kidney stones, persistent flank pain, blood in the urine, recurrent urinary infections or imaging that shows a kidney or ureteral stone.

Kidney Stone Treatment Options

The appropriate treatment depends on factors such as stone size, location, composition, symptoms, kidney anatomy and the patient's overall health.

RIRS is commonly considered for selected small to medium renal stones. For larger renal stones, particularly stones greater than 2 cm, PCNL is commonly considered as a first-line treatment in appropriate patients. The final treatment decision should be individualised.

How Is RIRS Surgery Performed?

The exact technique varies according to the patient's anatomy, stone characteristics and treatment plan. In general, RIRS involves the following steps:

Preparation Before RIRS Surgery

Before RIRS, the urologist will review your medical history, medicines, allergies, imaging and laboratory reports. Preparation varies according to your health and the planned procedure.

• Blood and urine investigations may be required.
• Imaging such as ultrasound or CT may be reviewed for treatment planning.
• Any urinary infection should be identified and appropriately treated before stone treatment.
• Tell your doctor about blood thinners, supplements and other medicines you are taking.
• Follow the hospital's instructions regarding fasting and medicines before anesthesia.

Recovery After RIRS

Recovery after RIRS varies between patients and depends on the stone burden, procedure performed, presence of a ureteral stent and the patient's overall health.

RIRS is minimally invasive and many patients can resume normal activities relatively quickly, but the exact recovery period should be determined by the treating urologist.

Temporary urinary frequency, mild discomfort or blood in the urine can occur, particularly when a ureteral stent has been placed.

Post-Treatment Care After RIRS

• Take prescribed medicines according to your doctor's instructions.
• Drink adequate fluids unless your doctor has advised fluid restriction.
• Attend scheduled follow-up appointments and imaging when advised.
• If a ureteral stent is placed, follow the instructions regarding stent removal or follow-up.
• Report fever, worsening pain, heavy bleeding, difficulty passing urine or other unexpected symptoms promptly.

Diet & Lifestyle After Kidney Stone Treatment

Removing a kidney stone does not necessarily prevent future stones. Long-term prevention depends on the type of stone and the factors that contributed to its formation.

• Drink adequate fluids unless fluid restriction has been advised.
• Limit excessive salt intake.
• Follow dietary recommendations appropriate for your specific stone type.
• Maintain a healthy body weight and remain physically active as appropriate.
• Follow personalised dietary advice if metabolic testing identifies a specific stone-forming risk.

Possible Complications of RIRS

RIRS is a minimally invasive procedure, but it still carries potential risks. Individual risk depends on the patient's health, stone characteristics, anatomy and complexity of the procedure.

• Urinary tract infection.
• Fever or postoperative infection.
• Blood in the urine.
• Temporary urinary discomfort or frequency.
• Ureteral injury, which may rarely result in a ureteral stricture.
• Residual stone fragments requiring further treatment.
• Temporary discomfort related to a ureteral stent.

Benefits of RIRS

• Accesses the kidney through the natural urinary passage.
• Does not require an external surgical incision.
• Allows direct visualisation and treatment of kidney stones.
• Can be useful for stones in locations that may be difficult to treat using other methods.
• Generally involves less tissue disruption than open stone surgery.

Risks and Limitations of RIRS

Although RIRS is minimally invasive, it is not completely risk-free. Infection, bleeding, ureteral injury, stent-related discomfort and residual stones are possible.

Very large or complex kidney stones may not be ideal for RIRS alone. Some patients may require staged procedures or another stone-treatment approach such as PCNL depending on stone burden and anatomy.

The final treatment plan depends on the number, size and location of stones, kidney anatomy, urinary infection, previous treatments and other individual medical factors.

RIRS Treatment Outcome and Follow-Up

The expected outcome after RIRS depends on stone size, location, composition, kidney anatomy and other patient-specific factors.

Smaller stone burdens may sometimes be treated in a single procedure, while larger or more complex stones may require staged treatment or additional procedures.

Follow-up imaging may be recommended to assess residual fragments and confirm the condition of the urinary tract.

Cost of RIRS Surgery in Thane

The cost of RIRS surgery varies depending on the stone size and location, number of stones, treatment complexity, hospital facilities, investigations, anesthesia, equipment and individual patient requirements.

For an accurate estimate, patients should discuss the expected treatment plan and associated hospital costs with the doctor after evaluation.