• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

UNDERSTAND RIRS – RETROGRADE INTRARENAL SURGERY FOR RENAL STONES

UNDERSTAND RIRS

RIRS or Retrograde Intrarenal Surgery is an endoscopic surgery performed to remove renal stones by reaching the kidney from the ureter. RIRS procedure uses a viewing tube called fibre optic endoscope and a laser fibre – Holmium – to treat the renal stones. Once the large stone is removed, small fragments of the stones are taken off through stone baskets. In some cases, a stent may be pushed in the kidney to improve drainage. In this procedure, the Stone is crushed, or blasted by using a laser probe or can also be manually removed through forceps. The surgery is performed by a urologist who has specialized expertise in RIRS. During the procedure, the patient is given spinal or general anesthesia and the endoscope is inserted in the body through the urethra then into the kidney; the surgery does not involve any incisions and hence, has a very fast recovery time. With RIRS a vast majority of renal stones can be cleared without open surgery.

Moreover, with the recent technological developments in the management of renal stones, RIRS has emerged as a very reliable, safe and efficient method. The main purpose of a renal stone treatment is to clear the stones completely with minimum morbidity – RIRS clears renal stones through flexible ureterorenoscopy and lithotripters including holmium laser, ensuring no trace of stones are left. Moreover, advancement in related equipment’s such as guide-wires, uretral access sheath and stone baskets have enhanced the effectiveness of the RIRS procedure. As of today, RIRS is a prime method of treatment for renal stones that are less than 2 cm and cannot be successfully treated via other methods.

A RIRS procedure is best suited for cases where:

  • Earlier attempts to remove renal stones have failed
  • Stones are large in size
  • There is a tumour in the kidney
  • The patient involved is a child
  • The patient has bleeding disorders
  • The patient is obese
  • The patient has complex anatomical kidneys
  • Patient is on anticoagulants

Procedure of the RIRS 

A retrograde intrarenal surgery is simple, less invasive and has fewer chances of any complications.

  • Before the Surgery: The doctor will conduct several tests to analyze the position of the stones, the general health conditions, as well as response to anesthesia – at least 2 weeks before scheduling a retrograde intrarenal surgery.The doctor may do the pre-operative stenting 2 weeks before to the actual procedure if needed in few cases; this stenting makes it easier for the ureteroscope to enter the kidneys easily since ureter is already dilated. Moreover, on the day of the surgery, the patient need to fast for at least 6 hours.
  • During the Surgery: The patient will be under the influence of anesthesia, and the urologist will use an endoscope – a thin, flexible tube – toreach thebladder through the urethra and then further to the area of urine storage in the kidney. During this process, the endoscope will identify stones and blast them with a laser. Further, the Dj stenting done two weeks’ prior helps to smoothen and fasten the recovery time; in most cases, patients are discharged on the next day post-surgery.
  • After the Surgery: Post completion of the surgery, a urine catheter can be placed in the urethra to reduce pain and problem while urinating; the catheter is placed for a day or longer as per case basis. The patient is then put in a recovery room and a 24-hour rest is advised. Further, the patient needs to drink a lot of fluids especially water to urinate at least 2.5 litres every day; this helps to keep infections away. Also, in case the patient is healthy and absolutely fit to resume everyday activities, he/she can be discharged right the next day of the surgery. However, a follow-up with the doctor is critical.

Advantages of the Surgery

Retrograde intrarenal surgery is one of the novel methods to treat renal stones. Some of the advantages of the RIRS method are:

  • Minimally invasive
  • Simple and quicker procedure
  • Shorter recovery time
  • Less painful
  • Less morbidity
  • Minimal bleeding
  • No risk to the renal tissue
  • Fewer complications

Risks of the Surgery

Complications or risks associated with RIRS are fairly uncommon and occur only in very few cases.

  • Fever
  • Flank pain
  • Urinary infection
  • Transient hematuria
  • Acute urinary retention
  • Ureteral pelvicalyceal abrasion
  • Fornix rupture
  • Ureter avulsion
  • Bleeding
  • Sepsis
  • Trauma to kidneys

That said, RIRS may not be a surgical option if the size of the renal stones is more than 20mm in diameter or there are several small stones. Such cases are not the ideal situations for RIRS and can be treated better through a different method.

In all, RIRS is an effective and feasible treatment for renal stones with high success rates and lower complications.

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