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Retrograde intra renal surgery (RIRS)

RIRS – Retrograde Intra Renal Surgery.

Advancement of technology in flexible telescopes saw the development of very thin flexible long telescopes whose tip could be bend to visualize 90% of the interior of the kidney. These telescopes of about 2.7mm diameter can be passed up the urethra into the bladder and from the bladder, up the ureter and into the kidney. This procedure is called RIRS or Retrograde Intra Renal Surgery.The ureter is a 2.5 to 4 mm diameter tube connecting the kidney to the bladder. The RIRS telescope can thus be passed as a single stage procedure. However, studies have shown that if this is done in 2 stages, the complication rate and stone clearance rates are better. Hence we prefer to place a stent as first stage and do RIRS 2 to 3 weeks later as a second stage procedure.

RIRS versus ESWL

RIRS is the prefered mode of treatment over ESWL for stones over 1 cm size as the stone clearance rate is much better. ESWL produces some contusion to kidney and surrounding organs and is reported to increase marginally the incidence of Diabetes and Hypertension in the long term. Therefore, when more than one session of ESWL is anticipated, RIRS is the preferred method of treatment. However, unlike ESWL which is an outpatient procedure, RIRS requires anaesthesia and therefore hospital admission. It is also more expensive as the instruments and telescopes for RIRS are very delicate and hence not durable.

RIRS versus PCNL

For stones larger than 2.5cm or very hard stones, PCNL may be a better choice when feasible. Direct access into the kidney in PCNL enalbles use of larger telescopes, stronger laser energy and the ability to remove the fragments. The same procedure by RIRS will require multiple sessions. RIRS however has less chance of major complications.

Your consultant will discuss the various procedures with advantages and disadvantages pertaining to your stone problem.

Before Surgery

You will have blood tests, ECG, Chest X ray etc to assess medical fitness for anaesthesia. This will be done by Urologist, Physician and Anaesthesiologist.

Stent Insertion

For reasons explained earlier, we prefer to pre stent 2 to 3 weeks before RIRS though this is not mandatory.

  • You will be prescribed laxatives to be had the day before procedure.
  • You will be admitted on the day of procedure in the morning.
  • You should be fasting (no food or drink) for 6 hours before the procedure.
  • Procedure is done usually in the afternoon.
  • You will be allowed to go home in the evening or next day afternoon as advised by the anaesthetist.

RIRS

  • 1. Admit at appointed time 1 day before surgery.

    You will have laxatives the day before surgery.

  • 2.Day of surgery

    • Time of surgery will be intimated by me the day before. Depending on when the previous surgery would get over, there may be a delay of an hour.
    • The surgery may last from 2 hours or more depending on the size, site and hardness of the stone.
    • You will be in the post operative ICU for about 4 hours before returning to your room.
    •  You will have a urinary catheter (tube in to the bladder) and an internal stent from kidney to bladder which you will not see. The internal stent helps to allow the stone fragments to pass into the bladder without causing pain.
  • 3. 1st day after surgery.

    • The urinary catheter is removed in the morning.
    • You do not require any further rest and will be discharged.
    • Commonest reason for extension of admission is infection.
    • After discharge you can resume all your normal activities without requirement of any rest. The urine may be blood stained due to passage of stones or simply because of the stent. There is no need to worry about this and this on its own requires no rest.
  • Follow Up

    Out patient review will be in about a week. You may be asked to take an X-ray on arrival before seeing the doctor to assess how the stone fragments are being passed. Stent is removed after adequate clearance of the stone fragments and is a simple outpatient procedure.

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