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