What is Retrograde Intrarenal Surgery (RIRS)

The Retrograde Intrarenal surgery is a procedure that makes use of a flexible ureterorenoscope to get access to smaller kidney stones and is also used in treating upper urinary tract tumors. The surgery involves no incision on the kidney while using a laser and a viewing tube known by the name fiberoptic endoscope, that goes through the urethra into the kidney. It is performed under general, spinal or local anaesthesia. The doctor can view the stone and crush it using an ultrasound probe and hence get the stones there.

The RIRS is a minimally invasive urology procedure which is used when other treatments have failed, kidney stones are too large for lithotripsy, strictures in the kidney, tumors in kidney, kidney stones in children, bleeding disorders in the kidneys, or obese people.

The RIRS surgery is prefered to others because this is not an open surgery, quicker results achieved, post surgery pain is short lived, making the recovery process faster. Only lithotripters are used for the fragmentation of stones in RIRS. Holmium lasers are used for every type of stone with a variable time  required for fragmentation.

Cost of retrograde intrarenal surgery:

Although the RIRS is an effective procedure with less complications, it has been an expensive procedure. Taking into account all the instruments that are used like the flexible ureteroscope, laser lithotripter, guide wire, ureteral access sheath and stone basket, the total cost for the surgery in India is about $ 3,000 per case. The cost could be lore as the devices used are very delicate and are to be used very carefully. The success rate of retrograde intrarenal surgery is between 65% and 95%.

In the pediatric group there is a rate of 1% to 2% with kidney stones, and this retrograde intrarenal surgery needs to be done as it is recurrent in this age group.

These are the following steps involved in the procedure of Retrograde intrarenal surgery:

• The kidney stone is located through the camera in a flexible ureteroscope tip.
• The stone is then fragmented till it becomes fine dust with a holmium laser energy.
• The stone dust is removed with the help of a basket..
• Urinary tract is cleared by flushing out the stone dust.
• This completes the treatment.

These are the benefits of RIRS for kidney stone removal over open surgery:

• The procedure of stone removal is much quicker
• Minimal or no pain after surgery.
• Recovery time is also faster in comparison to open surgery.
• The RIRS involves minimal bleeding.
• There is no damage done to the renal tissue.
• The procedure shows a better clearance of kidney stones.

Post operative care includes:

• The patient is taken to the recovery room for intensive care and monitored by nurses and medical staff.
• A urine catheter is fitted into the urethra for a day in order to reduce the pain during urination.
• Bed rest is advised for 24 hours after the RIRS and can get discharged the next day.
• A follow-up visit with the doctor is necessary after 5 days.