Retrograde intrarenal surgery (RIRS) is a minimally invasive endoscopic procedure used to treat selected kidney stones. It allows a specialist to reach stones inside the kidney through the natural urinary passage, without making an incision through the skin.

During RIRS, a thin, flexible instrument called a ureteroscope is passed through the urethra and bladder into the ureter and kidney. A laser is then used to break the stone into smaller fragments or fine particles, depending on the stone's characteristics and the treatment plan.

RIRS is commonly considered for appropriately selected kidney stones, particularly those for which an endoscopic approach is suitable. Stone size, location, density, urinary anatomy and the patient's medical condition all influence the decision.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides specialist kidney evaluation and management. When a kidney stone requires a procedure such as RIRS, assessment and coordination with an appropriately qualified urologist may be needed.

How Does RIRS Work?

RIRS uses the urinary tract as the route to the stone rather than accessing the kidney through an external incision.

The procedure generally involves the following steps:

1. Anaesthesia: The patient receives anaesthesia according to the planned procedure and individual medical needs.

2. Endoscope insertion: A flexible ureteroscope is passed through the urethra and bladder into the urinary tract.

3. Kidney access: The instrument is carefully advanced into the kidney to locate the stone.

4. Laser fragmentation: A suitable laser, commonly a holmium:YAG or thulium fibre laser, breaks the stone into smaller pieces.

5. Fragment management: Depending on the stone and the technique used, fragments may be removed with a small retrieval basket or left as fine particles to pass in the urine.

6. Stent placement, if required: A temporary ureteral stent may be inserted to support urine drainage after the procedure.

The exact steps vary according to stone characteristics, anatomy and the specialist's treatment plan.

Which Kidney Stones Can Be Treated With RIRS?

RIRS may be considered for stones in different parts of the kidney, including the renal pelvis and calyces. It may also be used for selected upper ureteral stones.

Whether it is the most appropriate option depends on several factors.

Small and Medium-Sized Kidney Stones

RIRS is commonly considered for selected renal stones measuring less than 20 mm. Other options, including shock wave lithotripsy and PCNL, may also be suitable depending on the stone's features.

Lower Pole Kidney Stones

Stones in the lower part of the kidney can be more challenging because the angle and width of the collecting system may make access and fragment clearance difficult.

RIRS may still be appropriate, but anatomy and stone size can influence success.

Large Kidney Stones

For stones larger than 20 mm, percutaneous nephrolithotomy (PCNL) is generally the preferred first-line procedure when suitable. RIRS may be considered when PCNL is unsuitable or contraindicated, but multiple sessions may be required.

RIRS Versus Other Kidney Stone Treatments

No single procedure is best for every kidney stone. The choice should be based on imaging findings, stone burden, kidney anatomy, infection status and overall health.

These treatments differ in invasiveness, stone-clearance rates, recovery and likelihood of needing additional procedures.

What Tests Are Needed Before RIRS?

Before recommending RIRS, the treating team needs to understand the stone's location and the condition of the urinary tract.

Imaging

A non-contrast CT scan is often useful for assessing stone size, number, density and location. Ultrasound and other imaging may also contribute to the evaluation.

Urine Testing

Urinalysis and urine culture may be required to look for infection. A urinary infection should be appropriately treated before planned stone removal.

Blood Tests

Depending on the patient's medical history, testing may include:

• Serum creatinine and eGFR

• Electrolytes

• Complete blood count

• Other tests required for anaesthesia or procedural planning

Medical and Medication Review

The team should review existing illnesses, allergies, current medicines and any history of previous stone procedures.

Blood-thinning medicines require particular attention. Do not stop or adjust them without instructions from the prescribing clinician and procedural team.

Preoperative evaluation helps identify infection risks, assess kidney function and determine whether RIRS is the appropriate treatment.

Is RIRS a Painful Procedure?

RIRS is generally performed under anaesthesia, so the patient should not experience the procedure in the usual way while it is being performed.

Afterward, some discomfort can occur, especially if a ureteral stent has been placed.

Possible temporary symptoms include:

• Burning during urination

• Mild blood in the urine

• Urinary urgency or frequency

• Flank discomfort

• Bladder irritation

The severity and duration vary between patients. Pain that is severe, worsening or accompanied by fever should not be assumed to be normal recovery.

What Is a Ureteral Stent After RIRS?

A ureteral stent is a thin tube placed between the kidney and bladder to help maintain urine flow.

The specialist may recommend a stent when there is concern about swelling, drainage, residual fragments or other procedural factors.

A stent can cause temporary symptoms such as urgency, frequent urination, bladder discomfort and blood in the urine.

Not every uncomplicated ureteroscopy requires a stent. When one is inserted, the patient should receive clear instructions about its removal or exchange date.

Important: Do not miss a scheduled stent-removal appointment. A stent left in place longer than intended can develop complications.

How Long Does Recovery After RIRS Take?

Recovery depends on the complexity of the procedure, stone burden, anaesthesia, presence of a stent and the patient's general health.

Some patients can return home relatively soon after an uncomplicated procedure, while others may need observation or additional treatment.

During recovery, follow the treating team's instructions about:

• Prescribed medicines

• Fluid intake

• Physical activity

• Wound-free urinary hygiene

• Stent care

• Follow-up appointments

• Imaging to confirm stone clearance

Do not force yourself to drink excessive amounts of water. Fluid advice should be individualized, especially for people with chronic kidney disease, heart failure or a prescribed fluid restriction.

What Are the Risks of RIRS?

RIRS is minimally invasive, but it is still a medical procedure with potential complications.

These may include:

• Urinary tract infection

• Fever

• Bleeding in the urine

• Ureteral irritation or injury

• Temporary obstruction from fragments or swelling

• Stent-related discomfort

• Residual stones

• Need for another procedure

• Rarely, severe infection or other significant complications

The risk depends on factors such as stone burden, pre-existing infection, medical conditions, anatomy and procedure duration. Infection prevention and appropriate procedural planning are important.

Can RIRS Remove All Kidney Stones in One Session?

Not always.

The possibility of complete clearance in one session depends on the number of stones, their size, hardness, location and the time safely available for the procedure.

Large or complex stones may require staged RIRS or another treatment approach. PCNL may be more appropriate for some large stones because it can achieve substantial clearance with fewer procedures.

The treatment goal is safe and effective stone management, not simply completing the procedure in a single session.

When Should You Seek Medical Help After RIRS?

Contact the treating team promptly if you develop symptoms that are severe, persistent or worsening.

Seek urgent medical assessment for:

• Fever or chills

• Severe or increasing flank pain

• Persistent vomiting

• Inability to pass urine

• Heavy bleeding or large blood clots in urine

• Marked weakness or confusion

• Difficulty breathing

Fever or chills after urinary stone surgery can indicate a serious infection. If a stone is obstructing the urinary tract and infection is present, urgent drainage and treatment may be necessary before definitive stone removal.

How Can You Reduce the Risk of Kidney Stones Returning?

RIRS treats the existing stone burden, but it does not automatically remove the reasons stones formed.

After treatment, prevention may include:

• Stone analysis when a specimen is available

• Appropriate fluid intake based on medical advice

• Reducing excessive dietary sodium

• Individualized dietary changes

• Metabolic evaluation for recurrent or high-risk stone formers

• Prescribed preventive medicines when indicated

• Follow-up urine and imaging tests as recommended

The ideal preventive plan depends on the stone's composition, medical history, kidney function and other risk factors.

Kidney Stone Evaluation at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized assessment of kidney health and conditions associated with kidney stones.

Depending on the patient's needs, evaluation may include:

• Reviewing CT scans and ultrasound reports

• Assessing creatinine and eGFR

• Checking for urinary infection

• Evaluating obstruction and kidney-function concerns

• Reviewing recurrent stone history

• Assessing medical conditions that affect treatment

• Coordinating with a urologist when RIRS, PCNL or another stone-removal procedure is being considered

• Planning kidney-function follow-up and stone prevention

The appropriate treatment depends on the stone's characteristics and the patient's overall health. RIRS should be recommended only after a suitable clinical assessment.

Frequently Asked Questions

What does RIRS stand for in kidney stone treatment?

RIRS stands for retrograde intrarenal surgery. It is an endoscopic procedure that uses a flexible ureteroscope to reach stones inside the kidney, usually followed by laser fragmentation.

Is RIRS better than laser surgery?

RIRS is itself a type of endoscopic procedure that commonly uses a laser to break kidney stones. The relevant comparison is usually between RIRS, other ureteroscopic approaches, ESWL and PCNL.

Is RIRS suitable for a 2 cm kidney stone?

It may be considered in selected circumstances, but PCNL is generally the preferred first-line option for renal stones larger than 2 cm when appropriate. RIRS can require multiple sessions for large stones.

Is a stent always needed after RIRS?

No. A stent is not required after every uncomplicated procedure. The decision depends on drainage, swelling, residual fragments and other clinical factors.

Can kidney stones come back after RIRS?

Yes. Removing stones does not eliminate the underlying risk factors. Stone analysis, preventive measures and follow-up may help reduce recurrence.

How do I know whether RIRS has worked?

The treating team may use follow-up imaging and review symptoms to assess whether stones or fragments remain. The timing and type of imaging depend on the procedure and clinical situation.

Conclusion

RIRS for kidney stone removal offers a minimally invasive way to reach selected kidney stones through the natural urinary passage and fragment them using a laser. It avoids an external incision into the kidney, but it is not the best option for every stone.

Stone size, location, density, urinary anatomy, infection status and kidney function all influence treatment selection. Some patients achieve satisfactory clearance in one session, while others need a stent, staged treatment or an alternative procedure such as PCNL.

Proper preoperative assessment, infection management, follow-up and recurrence prevention are important parts of care.

For individualized kidney evaluation and coordinated stone-treatment planning, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is for general educational and informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. RIRS suitability depends on stone size, location, anatomy, infection status, kidney function and the patient's overall health. The procedure may involve complications or require additional treatment. Do not delay urgent care for fever, chills, severe flank pain, persistent vomiting or inability to pass urine. Do not change medicines, fluid intake or stent-care instructions without consulting the treating team. Consult Dr. Sandip Prabhakar Bhurke or another qualified healthcare professional for personalized assessment and appropriate coordination with a urologist when a stone-removal procedure is needed.