Retrograde Intrarenal Surgery

The success of a surgery depends quite a lot on the sophistication of the tools used during the procedure. The surgeon needs proper equipment to view the internal tissues of the patient to properly conduct the surgery. Retrograde Intrarenal Surgery is a technique that allows the urologist to properly view the internal structure of the kidney, ureter, and bladder and can also remove urinary stones and perform other related surgeries.

What is Retrograde Intrarenal Surgery?

Retrograde Intrarenal Surgery (or RIRS) is a procedure where a viewing tube, also known as a fiberoptic endoscope, is passed in to the kidney during the surgery. This fibro-optic scope is flexible so that it can bend with the natural curvature of the renal system and thin enough to go in to small caliber of ureter and kidney, and tip of the scope can be bent 320 degrees to enter in to crevices of the kidneys. This scope is placed through the urethra into the bladder. It is then moved up the ureter ( retrograde) into the Renal pelvis, part of the kidney collecting urine (intrarenal). Then the stones is visualized in various part of the kidney. Then a thin LASER fiber is passed through the scope and stones are powdered in to very minute particles so that it can get washed out along with saline irrigation or with urine . Manual removal through forceps could also be an option.

Who needs a RIRS?

RIRS is generally performed under spinal or general anaesthesia,. The surgery is performed inside the kidney without the need for any out side cuts. It is made possible by moving the instrument up through the urethra and placing it into the kidney under the guidance of fluoroscopy ( live x ray inside the operation room). Small epithelial tumours could also be the be treated by RIRS. It is a minimally invasive urology procedure and is used to treat difficult cases. Some of these are:

strictures in the kidney
kidney stones that are too large to be removed by lithotripsy
kidney stones in children
bleeding disorders in the kidneys
obese patients
failures in other treatment methods

What should you expect throughout the surgery?

Regular checkups are necessary before the surgery to ascertain the health condition of the patient. Some time DJ stent may be inserted about 2 weeks prior to the RIRS surgery if ureter is found to be narrow. The surgery can be expected to last about 1-2 hours. This technique of surgery is used to treat stones measuring up to 1.5 cm in diameter. Larger stones takes longer LASER time thus PCNL is preferred method. Post surgery A DJ stent is passed and kept for three to four weeks. A urinary catheter is passed and kept for a day or two. The patient is advised to have proper bed rest for 24 hours at the least. Drinking plenty of water is advised to maintain proper urine output. The patient might even be discharged the day after surgery depending on his or her condition. Patient is advised for antibiotics and pain killers for 5 days. Patients is followed at 1 week and then called back after three weeks for checking clearance of stones and then DJ stent is removed.

What are the advantages of RIRS?

RIRS leads to a quicker extraction of the stones compared to traditional methods.
The patients do not have to endure much pain through the entire process.
The blood loss is minimal and there is no damage done to the renal tissue.
The recovery also happens quite fast.
The procedure offers better results in clearing kidney stones in single sittings.
No external cut on the skin to enter kidney.

RIRS is a safe procedure to treat renal calculi, or kidney stones. This procedure is suitable for renal stones up to 1.5 cm.

Authored By : Dr. Mahendra Jain