Retrograde Intrarenal Surgery (RIRS) is a modern, minimally invasive urological procedure used to diagnose and treat diseases of the kidney, most commonly kidney stones. Over the past two decades, RIRS has become an important alternative to open surgery due to advances in endoscopic technology and laser systems.
RIRS is a surgical technique in which a flexible ureteroscope is passed through the natural urinary tract—starting from the urethra, through the bladder and ureter, and into the kidney. Because the procedure follows the natural pathway of urine flow in reverse (retrograde), no surgical incision is required.
Indications for RIRS
RIRS is primarily used for:
- Kidney stones, especially those smaller than 2 cm
- Stones that are difficult to treat with shock wave therapy
- Residual stones after previous procedures
- Anatomical abnormalities of the kidney
- Diagnostic evaluation of certain kidney conditions
Procedure
The surgery is performed under general anesthesia. A flexible ureteroscope is guided into the kidney, allowing direct visualization of the stone. A laser (commonly a holmium laser) is used to break the stone into smaller fragments. These fragments are either removed or allowed to pass naturally in urine. In many cases, a temporary ureteric stent is placed to ensure smooth urine drainage after the procedure.
Surgical Technique
The procedure is performed under general anesthesia. After cystoscopy, a guidewire is passed into the ureter. A ureteral access sheath may be inserted. The flexible ureteroscope is advanced into the renal pelvis and calyces. The stone is visualized and fragmented using laser lithotripsy. Small fragments are either extracted or left to pass spontaneously. A ureteric stent is placed in most cases.
Advantages of RIRS
RIRS offers several benefits:
- Minimally invasive with no external cuts
- Reduced pain and faster recovery
- Short hospital stay
- Low risk of complications
- Can access almost all areas of the kidney
Limitations
Despite its advantages, RIRS has some limitations:
- Longer operative time for large stones
- Higher cost due to specialized equipment
- May require multiple sessions for complex cases
Complications
RIRS is generally safe, but minor complications may occur, such as:
- Temporary blood in urine
- Mild infection
- Ureteric injury (rare)
Serious complications are uncommon when the procedure is performed by experienced surgeons.
Postoperative Care
Patients are usually discharged within 24 hours. Adequate hydration, medications, and follow-up visits are important. If a stent is placed, it is removed after a short period.
Comparison with Other Modalities
| Treatment | Invasiveness | Ideal Stone Size | Hospital Stay |
|---|---|---|---|
| ESWL | Non-invasive | < 1.5 cm | Outpatient |
| RIRS | Minimally invasive | ≤ 2 cm | 1–2 days |
| PCNL | Invasive | > 2 cm | 3–5 days |
Conclusion
Retrograde Intrarenal Surgery represents a significant advancement in the management of kidney stones and other renal conditions. Its minimally invasive nature, high success rate, and patient comfort make it a preferred treatment option in modern urology.RIRS Surgery generally costs around US $1000 depending on the hospital and surgeon.
