RIRS

Overview

RIRS, also known as retrograde intrarenal surgery, is a procedure used for removing stones from the kidney. The procedure uses a viewing tube (called fiberoptic endoscope) through the urethra into the bladder inside the ureter and then into the kidney. A laser probe or ultrasound probe is used to crush or manipulate the stone in the kidney.

The benefits of RIRS are many and include faster recovery, quicker solution to kidney stone problem and minimization of prolonged pain after the surgery. Specialists who perform the surgery are also called urologists.

During the procedure, the stones are observed through the endoscope before removing them. This is an outpatient procedure suitable for patients suffering from narrowing of the kidney outlet, kidney stones and kidney tumours.

RIRS has many advantages owing to its minimally invasive technique that helps to treat:

• Tumours in the kidney
• Kidney stones in children
• Failed attempts at treatment
• Bleeding in the kidneys
• Strictures in the kidney
• Better clearance of kidney stones
• No damage to renal tissues
• Minimal bleeding
• Large kidney stones that cannot be removed by lithotripsy

Compared to a traditional open surgery, RIRS uses a very advanced technique for the extraction of stones, be it larger than 20 mm or several small calculi. Before RIRS procedure, there are specific preparations to be taken.

Before the treatment

• Several X-rays and imaging tests are done to help your doctor determine the position of the stone/stones. Your general health condition is evaluated to ascertain how your body will respond to anaesthesia.
• A thorough physical examination is done for an elaborate check up of your health conditions like heartbeat, pulse rate, conditions of the kidney and heart and other related tests. It helps your doctor to understand if you are fit to undergo the RIRS surgery.
• Two weeks before RIRS surgery, doctors perform a pre-operative DJ stenting.
• You are required to do fasting 4-6 hours before the surgery.

How it is performed

• After you are given general anaesthesia, surgeons insert an endoscope through the urinary tract inside the bladder. The endoscope is further placed through the urethra into the parts of the kidney where the urine collects.
• The scope is moved upwards through the urinary tract system and inside the intra-renal or within the kidney. There aren't any incisions required in the procedure.
• Uteroscope is used to enter it through the bladder, but before the procedure the scope is dilated by placing a Dj stenting in the kidney a couple of weeks before the surgery.
• The uterescope inserted helps to extract kidney stones (maximum of 1.5cm in size) easily. The stones are easily identified by the scope when passing it into the kidney through the bladder. The stones are then blasted by using laser rays or plucked by a Urology basket.
• After RIRS procedure, double Dj stent is put inside for smooth drainage from the ureter and the kidney.
• Since no cuts are done, there is no need requirement to close them either.

Recovery

After the RIRS procedure, the patient is taken to the recovery room where a urine catheter is placed in the urethra to help in drainage and minimize pain. The patient is instructed to rest 24 hours after receiving spinal anaesthesia and drink 2.5 litres of water to help keep infections away.

Patients are usually discharged the day after the surgery if they recover quickly. Doctor, however, want to check the patient after a week of the procedure. Listening to the doctor's advices related to post-care surgery helps in quicker recovery of RIRS procedure. There is minimal bleeding involved, faster recovery and quicker extraction of stone without any problem.