RIRS, or retrograde intrarenal surgery, is a minimally invasive procedure used to treat selected kidney stones.

Instead of making an incision through the skin, the surgeon reaches the kidney through the body's natural urinary passage. A thin, flexible instrument called a flexible ureteroscope is guided through the urethra, bladder and ureter until it reaches the kidney.

A laser may then be used to fragment the stone into smaller pieces. Depending on the stone and treatment strategy, fragments may be removed using a small basket or left as sufficiently small pieces to pass naturally.

RIRS is particularly useful for selected renal stones when an endoscopic approach is considered appropriate.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides specialist evaluation of kidney function and kidney-stone-related problems and can coordinate appropriate procedural care when required.

Why Is RIRS Used for Kidney Stones?

The choice of kidney-stone treatment depends on several factors rather than stone size alone.

Doctors may consider:

• Stone size

• Stone location within the kidney

• Number of stones

• Stone density and composition

• Kidney anatomy

• Urinary obstruction

• Infection

• Previous stone procedures

• Overall health

• Kidney function

• Patient preference

RIRS may be considered when a flexible endoscopic approach offers a suitable way to reach and treat the stone.

For some larger or complex renal stones, PCNL may provide a more appropriate approach. In selected situations, shock wave lithotripsy may also be considered.

What Does RIRS Stand For?

RIRS stands for Retrograde Intrarenal Surgery.

“Retrograde” refers to the direction in which the instrument travels through the urinary tract toward the kidney.

“Intrarenal” means that the procedure is performed inside the kidney.

The technique is closely related to flexible ureteroscopy and is often described as flexible ureteroscopy or RIRS with laser lithotripsy.

How Is RIRS Kidney Stone Surgery Performed?

Although the exact technique varies, the procedure generally involves several stages.

1. Anesthesia

RIRS is usually performed under anesthesia so that the patient remains comfortable during the procedure.

2. Access Through the Urinary Tract

The surgeon introduces a small endoscope through the urethra and bladder.

No external kidney incision is normally required for the endoscopic route.

3. Reaching the Kidney

The flexible ureteroscope is advanced through the ureter toward the kidney.

Its flexibility allows the surgeon to navigate different parts of the renal collecting system.

4. Identifying the Stone

The stone is visualized directly through the scope.

Its location, size and appearance help determine the appropriate method of fragmentation.

5. Laser Fragmentation

A laser fiber can be used to break the stone into smaller pieces.

The surgeon may use different laser settings and techniques depending on the stone characteristics and treatment objective.

6. Removing Stone Fragments

Larger fragments may be retrieved with a small basket.

Very small fragments may be left to pass through the urinary tract when considered appropriate.

7. Ureteral Stent Placement

A temporary ureteral stent may be inserted at the end of the procedure in selected patients.

The stent helps maintain urine drainage while the urinary tract recovers.

Is RIRS a Laser Surgery?

RIRS itself refers to the endoscopic route used to reach the kidney.

Laser lithotripsy is commonly used during RIRS to fragment the stone.

Therefore, when people search for “RIRS laser surgery,” they are usually referring to RIRS in which a laser is used to break the kidney stone.

The laser does not remove the entire kidney stone by itself. The stone is fragmented, and the resulting pieces are managed according to their size and the surgical strategy.

Which Kidney Stones Can Be Treated With RIRS?

RIRS can be used for a range of selected renal stones.

It may be considered for:

• Renal pelvis stones

• Upper, middle or lower calyceal stones

• Multiple kidney stones

• Stones unsuitable for or resistant to shock wave treatment

• Selected stones in patients for whom a minimally invasive endoscopic approach is preferred

However, RIRS is not automatically the best procedure for every stone.

Large stone burdens, complex anatomy, infection or other factors may make PCNL or another treatment more appropriate.

RIRS for Lower Pole Kidney Stones

Lower pole stones can present a particular treatment challenge because fragments may have difficulty moving out of the lower calyx after fragmentation.

RIRS can directly reach many lower-pole stones and may therefore be considered in appropriate patients.

Treatment planning may depend on:

• Infundibulopelvic anatomy

• Stone size

• Stone density

• Number of stones

• Previous treatment

• Kidney anatomy

The imaging findings should be reviewed before deciding between RIRS, shock wave lithotripsy and PCNL.

RIRS vs ESWL for Kidney Stones

Both RIRS and extracorporeal shock wave lithotripsy (ESWL/SWL) can be used for selected kidney stones, but they work differently.

RIRS

• Uses a flexible endoscope

• Reaches the stone directly

• Commonly uses laser fragmentation

• Does not require an external kidney incision

• May provide more direct control over stone fragmentation

ESWL

• Uses externally generated shock waves

• Does not require an endoscope to reach the stone

• Stone fragments pass through the urinary tract afterward

• Success can be affected by stone density, size, location and body habitus

The best option depends on individual stone characteristics.

RIRS vs PCNL

PCNL involves creating a small access tract through the skin directly into the kidney.

It is commonly considered for larger or complex renal stone burdens.

RIRS reaches the kidney through the urinary tract and may be preferable for selected stones where an endoscopic approach is suitable.

For a large stone burden, PCNL may provide more efficient stone clearance in a single procedure, although individual circumstances vary.

The decision should be based on imaging and specialist assessment rather than choosing a procedure solely because it is minimally invasive.

Does RIRS Completely Remove the Kidney Stone?

The objective is effective stone clearance, but complete clearance cannot be guaranteed in every procedure.

Factors that influence the outcome include:

• Stone burden

• Stone composition

• Stone density

• Location

• Kidney anatomy

• Number of stones

• Visibility and access during surgery

Large or multiple stones may require staged RIRS procedures.

Follow-up imaging may be recommended to determine whether clinically significant residual fragments remain.

Can RIRS Be Done for Multiple Kidney Stones?

Yes, selected patients with multiple renal stones can undergo RIRS.

However, the total stone burden is important.

If there are numerous or very large stones, treating everything in one session may not be appropriate.

The surgeon may recommend staged procedures or another technique such as PCNL depending on the stone burden and anatomy.

What Tests Are Needed Before RIRS?

Preoperative evaluation commonly includes a review of imaging and laboratory results.

Depending on the patient, this may include:

Imaging

• Ultrasound

• Non-contrast CT

• X-ray in selected cases

CT imaging can provide detailed information about stone size, location, density and urinary anatomy.

Urine Testing

A urine examination and, when appropriate, urine culture may be performed.

An active urinary infection needs appropriate treatment before elective definitive stone removal.

Blood Tests

The medical team may assess:

• Serum creatinine

• eGFR

• Hemoglobin

• Electrolytes

• Other relevant parameters

These tests help determine whether the kidneys and the patient are medically ready for the procedure.

What Happens If There Is an Infection Before RIRS?

An infected obstructed urinary tract can become a serious medical emergency.

If a patient has fever, chills, urinary obstruction and evidence of infection, the priority may be urgent drainage of the obstructed system, rather than proceeding immediately with definitive stone fragmentation.

Drainage may involve a ureteral stent or nephrostomy depending on the clinical situation.

Definitive stone treatment is generally planned after the infection has been appropriately controlled.

Is a Stent Necessary After RIRS?

Not every patient requires a stent for the same duration, and some carefully selected procedures may be completed without one.

A stent may be used when the treating team wants to:

• Maintain urine drainage

• Reduce the risk of temporary obstruction

• Allow the ureter to recover

• Facilitate passage of stone fragments

• Manage ureteral swelling

A stent is generally temporary and should be removed or exchanged according to the planned schedule.

What Does a RIRS Stent Feel Like?

A ureteral stent can cause temporary urinary symptoms.

Some patients experience:

• Frequent urination

• Urgency

• Burning while urinating

• Flank discomfort

• Bladder discomfort

• Blood in urine

The severity of symptoms varies.

Patients should follow the treating team's instructions and should not ignore severe pain, fever, chills or significantly reduced urine output.

RIRS Kidney Stone Surgery Recovery

Recovery after RIRS varies according to the stone burden, number of treated stones and whether a stent was placed.

For a straightforward procedure, many patients can resume routine activities relatively quickly, but the treating surgeon determines when normal activity is appropriate.

Temporary symptoms can include:

• Mild urinary burning

• Blood-tinged urine

• Increased urinary frequency

• Flank discomfort

• Stent-related discomfort

Follow-up may include imaging or urine testing to assess recovery and stone clearance.

What Should You Do After RIRS?

After the procedure, patients should follow their specialist's individualized instructions regarding:

• Medicines

• Fluid intake

• Physical activity

• Stent care

• Follow-up appointments

• Imaging

• Infection warning signs

Do not deliberately drink excessive quantities of water in an attempt to force residual fragments out, particularly if there is a fluid restriction or another medical condition affecting fluid balance.

What Are the Risks of RIRS?

RIRS is generally considered a minimally invasive procedure, but complications are possible.

Potential risks include:

• Urinary infection

• Bleeding

• Ureteral irritation

• Ureteral injury

• Stent discomfort

• Residual stone fragments

• Temporary urinary symptoms

• Need for another procedure

• Rare ureteral narrowing or other complications

The risk profile depends on the patient's health, stone characteristics and procedural complexity.

Can RIRS Damage the Kidney?

Any urinary procedure carries potential risks, but RIRS is designed to treat stones while preserving the kidney.

The surgeon considers the stone burden, anatomy, infection status and other factors when planning treatment.

Appropriate patient selection and careful technique are important in reducing complications.

A person with existing kidney impairment may require additional medical assessment before treatment.

How Long Does RIRS Take?

Procedure duration varies significantly.

A small solitary stone may be treated relatively quickly, whereas multiple or complex stones may require a longer procedure.

Stone size, location, anatomy, access and the need for staged treatment all influence the duration.

Patients should ask their treating surgeon for an estimate based on their specific imaging.

Can Kidney Stones Come Back After RIRS?

Yes.

RIRS removes or fragments the existing stone but does not necessarily eliminate the metabolic or dietary factors that caused stone formation.

Future stones may be associated with:

• Low fluid intake

• High sodium intake

• Certain dietary patterns

• Metabolic abnormalities

• Recurrent urinary infections

• Family history

• Specific medical conditions

Stone analysis and metabolic evaluation can be useful for selected patients, especially those with recurrent stones.

How Can You Prevent Another Kidney Stone?

Stone prevention should be individualized according to the type of stone and the patient's risk factors.

General measures may include:

• Maintain appropriate fluid intake as advised by your doctor.

• Avoid excessive dietary sodium.

• Follow a balanced diet.

• Take preventive medicines when prescribed.

• Complete metabolic evaluation when recommended.

• Treat recurrent urinary infections appropriately.

• Attend follow-up appointments.

Patients with CKD or other medical conditions should not make major dietary or fluid changes without professional guidance.

When Should You Contact a Doctor After RIRS?

Contact the treating team promptly if you develop:

• Fever or chills

• Severe or worsening pain

• Persistent vomiting

• Very little or no urine

• Significant bleeding

• Severe weakness

• Confusion

• Symptoms suggesting urinary infection

Fever following a urinary procedure can be particularly important because infection may require prompt treatment.

Kidney Stone and RIRS Evaluation at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized kidney evaluation for patients with kidney stones and associated kidney-function concerns.

Depending on the clinical situation, evaluation may include:

• Review of CT or ultrasound findings

• Assessment of kidney function

• Creatinine and eGFR monitoring

• Evaluation of urinary obstruction

• Infection assessment

• Review of recurrent stone history

• Assessment of metabolic risk factors

• Medical kidney management before or after stone procedures

• Coordination with appropriate urological specialists when RIRS or another stone-removal procedure is indicated

The appropriate treatment depends on stone size, location, composition, anatomy, infection status, kidney function and overall health.

Frequently Asked Questions

What is RIRS surgery for kidney stone?

RIRS is a minimally invasive endoscopic procedure in which a flexible ureteroscope is passed through the urinary tract into the kidney to visualize and treat selected renal stones, commonly using laser lithotripsy.

Is RIRS better than laser treatment?

RIRS describes the route and endoscopic procedure, while laser lithotripsy is a technique commonly used during RIRS to fragment the stone. They are not competing treatments.

Is RIRS suitable for a large kidney stone?

It can be suitable for selected larger stones, but PCNL may be preferred for some large or complex renal stone burdens. Imaging and stone characteristics determine the choice.

How many days does it take to recover from RIRS?

Recovery varies. Some patients resume routine activities relatively quickly, while others may need more time because of stone burden, staged treatment or stent-related symptoms. The treating team provides individualized activity advice.

Is a stent always required after RIRS?

No. Stent placement depends on the procedure, ureteral condition, stone fragments, drainage needs and the surgeon's assessment.

Can RIRS be repeated?

Yes. Staged or repeat RIRS may be recommended when a large or multiple-stone burden cannot be safely cleared in one procedure.

Can RIRS completely remove kidney stones?

RIRS can achieve effective stone clearance in many appropriately selected patients, but residual fragments can occur, particularly with large or multiple stones. Follow-up imaging may be required.

What is the difference between RIRS and PCNL?

RIRS reaches the kidney through the natural urinary passage using a flexible scope, while PCNL creates a small access tract through the skin into the kidney. PCNL is commonly considered for larger or complex stone burdens.

Conclusion

RIRS surgery for kidney stone is a minimally invasive endoscopic treatment that allows selected kidney stones to be reached through the urinary tract and fragmented, commonly with laser technology.

It can be an effective option for appropriately selected renal stones, but it is not automatically the best procedure for every patient. Stone size, location, density, number, kidney anatomy, infection status and kidney function all influence treatment selection.

Some patients may need a temporary ureteral stent, and larger or multiple stones may require staged treatment. Appropriate follow-up is also important to confirm stone clearance and reduce the risk of recurrence.

If you have been diagnosed with a kidney stone and are considering RIRS, a specialist assessment of your imaging and kidney function can help determine whether the procedure is appropriate.

For individualized kidney evaluation and stone-related care, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and should not be considered a substitute for medical diagnosis, treatment or individualized medical advice. RIRS is not suitable for every kidney stone, and the appropriate treatment depends on stone size, location, density, number, anatomy, urinary obstruction, infection status, kidney function and overall health. RIRS, laser lithotripsy, ESWL and PCNL have different indications, benefits and risks. Do not delay urgent medical care if a kidney stone is accompanied by fever, chills, severe worsening pain, persistent vomiting, very little or no urine, confusion or other signs of serious illness. Do not change medicines or fluid intake without professional guidance. Consult Dr. Sandip Prabhakar Bhurke or another qualified kidney or urinary stone specialist for an individualized treatment plan.