RIRS Surgery

RIRS, or retrograde intrarenal surgery, is a minimally invasive procedure used primarily to remove kidney stones from the kidney. It uses a flexible fiberoptic endoscope inserted through the urethra and bladder into the ureter and up into the kidney. Using laser energy, the stones are fragmented into smaller pieces that can be more easily removed through the urinary tract. This technique avoids the need for any external incisions.

Anatomy and Physiology of the Kidney

The kidneys are two bean-shaped, reddish-brown organs about the size of a fist. They are located on either side of the spine, just below the rib cage in the back of the abdomen. The anatomy of kidneys is as follows:

1. They are surrounded by a tough fibrous capsule and protected by a fat layer.

2. Each kidney is divided into an outer cortex and an inner medulla. 

3. The cortex contains nephrons, which filter blood. 

4. The medulla has the renal tubules, through which urine flows into the renal pelvis (it collects urine and passes it to the two ureters).

The kidneys have several important functions. Some of these include: 

1. Blood filtration 

2. Urine formation 

3. Excretion of wastes, such as urea, creatinine, and acids

RIRS is recommended for patients who have kidney stones that are difficult to manage with non-invasive or other less-invasive treatments. The following are specific circumstances where this surgery may be considered necessary:

1. Stones that are too large for lithotripsy (more than 2 cm in diameter)

2. Strictures in the kidney (narrowings that obstruct the urine flow) 

3. Small tumours within the kidneys  

4. Kidney stones in paediatric patients 

5. Patients with bleeding disorders like haemophilia (RIRS reduces the risk of bleeding)

The RIRS surgery takes 45 to 60 minutes to complete. The duration can vary depending on the complexity of the procedure and the patient’s condition. The steps involved in the operation are as follows: 

1. RIRS is performed under general, local, or spinal anaesthesia, ensuring the patient is pain-free throughout the procedure.

2. The surgeon begins by inserting a flexible ureteroscope into the urethra, then advancing it through the bladder and up the ureter into the kidney.

3. Once the stone is located, the surgeon visualises the surgical area using a camera and light on the ureteroscope.

4. They pass a laser fibre through the ureteroscope to fragment the kidney stones into smaller, passable pieces. 

5. Smaller stone fragments are removed using a basket-like device through the ureteroscope or left to pass naturally in the urine.

6. Sometimes, the surgeon may place a temporary DJ stent from the kidney to the bladder to facilitate urine drainage and promote healing.

Patients meet with a urologist to prepare for their RIRS surgery. The specialist provides specific instructions to be followed both before and on the day of the procedure. These guidelines generally include:

Before RIRS 

Preparations begin about two weeks before the surgery. Patients undergo all the necessary tests to ensure they are fit for the procedure. Other guidelines prior to RIRS are as follows: 

On the Day of RIRS 

Patients must arrive at the hospital before their scheduled RIRS procedure to allow time for any final administrative details. Upon arrival, they will undergo preparation for the surgery, which includes:

Discomfort post-procedure is common but temporary. RIRS surgery recovery time is relatively quick. Most patients can resume activities within 3-4 days after the procedure. Recovery begins in the hospital and continues at home. 

Recovery in the Hospital 

RIRS is generally an outpatient procedure, meaning patients can return home on the same day of the surgery. However, they may need to stay in the hospital a little longer if there are any complications. One can expect the following in the hospital: 

1. After RIRS, patients are moved to a recovery area where they are closely monitored until the effects of anaesthesia wear off. Vital signs are checked regularly to ensure stability.

2. A urine catheter is inserted into the urethra to facilitate easy urination for patients. 

3. Doctors prescribe medications to manage pain. 

4. Hydrating well after the procedure is important to help flush out any remaining stone fragments.

At-home Recovery

During this phase, patients continue their healing process in the comfort of their own homes. Adhering to the following prescribed care guidelines is important for a smooth and effective recovery: 

1. Rest and Activity: Patients are advised to rest for the first 24 hours. Strenuous activities and heavy lifting should be avoided for a month to prevent complications.

2. Medication Management: Pain can usually be managed with over-the-counter pain relievers, as the doctor recommends.

3. Hydration: Drinking 8-10 litres of fluids daily is vital to help clear any residual stone fragments left in the kidneys or urinary tract. However, patients should not consume caffeinated beverages or alcohol. 

4. Diet: Individuals should eat a fibre-rich diet after RIRS. They should avoid foods that cause constipation and straining during bowel movements. 

First Follow-up Appointment

The first follow-up visit after RIRS is scheduled 5-7 days after the procedure. During this appointment, the healthcare team ensures that all fragments have been removed and monitors for any delayed complications from the surgery. Imaging tests may be performed to confirm that the urinary tract is clear.

RIRS treatment for kidney stones offers various benefits to patients compared to conventional methods. It allows access to the kidney via the urinary tract without needing external incisions. Some other advantages of the surgery are as follows: 

1. Same-day discharge.

2. Quick recovery (return to normal activities within 3-4 days).

3. High precision in stone targeting and treatment.

4. Low risk of complications compared to other invasive procedures.

5. Effective for a wide range of patients, including those who are not eligible for other surgeries.

RIRS is a safe and effective method for treating kidney stones. However, like all surgical procedures, it carries some potential risks. According to a study by Corrales et al., 2022, the overall complication rate after the procedure is 9% to 25% and may include the following: 

1. Urinary tract infections 

2. Haematuria (blood in the urine)

3. Sepsis (the body reacts extremely to an infection)

4. Flank pain (discomfort in the upper abdomen or back and sides)

5. Tears or perforation in the ureter 

6. Failure to completely remove stones 

When to consult a doctor? 

After undergoing RIRS, it is essential to monitor signs that indicate complications. Patients should consult a doctor if they experience any of the following symptoms after the surgery:

1. Fever above 100.4 F

2. Severe pain while urinating 

3. Trouble urinating or a significant decrease in urine output 

4. Persistent or heavy bleeding 

If RIRS is delayed when recommended, the underlying condition may worsen. This can lead to several risks, such as: 

1. Increased stone size, making them more difficult to remove later 

2. Blockages in the urinary tract, leading to urine flow obstruction

3. Severe pain 

4. Repeated urinary and kidney infections 

5. Permanent kidney damage 

Cost of RIRS Surgery 

The RIRS surgery cost in India can vary depending on several factors. Generally, it starts at ₹ 50,000 and goes up to ₹ 1,80,000. The average price of the procedure is ₹ 90,000. 

Note: The expenses mentioned above are approximate. Patients should consult HexaHealth experts for accurate prices. 

Factors that affect the cost of RIRS include: 

1. Healthcare Facility: The choice of hospital or clinic can affect the cost. A private medical centre is generally more expensive than a government one. 

2. Geographical Location: Facilities in metropolitan areas are costlier than those in smaller cities due to differences in the general cost of living. 

3. Surgeon's Expertise: The experience and reputation of the urologist performing the surgery can influence prices. Highly skilled surgeons charge more for their services.

4. Complexity of Procedure: Patients with larger stone sizes or those requiring additional procedures like stent placement may incur higher expenditures. 

5. Pre and Post-operative Care: The final bill includes costs for pre-operative evaluations (like imaging studies) and post-operative care (like follow-up visits). 

RIRS offers a minimally invasive solution for patients suffering from kidney stones. This technique reduces the physical trauma associated with traditional stone removal surgeries. As a result, it promotes quicker healing and less postoperative discomfort. 

When comparing RIRS vs PCNL (percutaneous nephrolithotomy), we help patients understand the benefits and limitations of each procedure. We ensure you make informed decisions based on your condition and health requirements.

HexaHealth offers a personalised approach to treatment that includes thorough diagnostic assessments, expert surgical execution, and dedicated post-operative care. 

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