Retrograde Intrarenal Surgery (RIRS): A Comprehensive Guide

Retrograde Intrarenal Surgery (RIRS) is an advanced, minimally invasive technique used primarily to treat kidney stones. This blog will explore the details of the RIRS surgery procedure, preparation steps, benefits, and care after surgery.

Introduction to RIRS

RIRS is a technique in urology that utilizes endoscopic equipment to treat kidney stones without the need for any incisions. This procedure is performed using a flexible ureteroscope, which is inserted through the urethra.

What Happens During RIRS Surgery?

Diagnosis Before RIRS

• Imaging Tests: Includes KUB X-ray, abdominal ultrasound, and MRI to locate stones.
• Blood Tests: Blood urea nitrogen (BUN) and other routine blood tests to assess overall health.
• Urinalysis: To check for signs of infection or other underlying issues.

RIRS Surgery Procedure

Anesthesia

The RIRS surgery begins with the administration of anaesthesia to ensure the patient remains comfortable and pain-free throughout the surgery. Depending on the patient’s health, preference, and the complexity of the procedure, either spinal or general anaesthesia may be used:

• Spinal Anesthesia: Involves numbing the lower part of the body, allowing the patient to stay awake without feeling pain.
• General Anesthesia: The patient is completely sedated, ensuring they are unconscious during the procedure, which is typically recommended for longer or more complex cases.

Insertion of Endoscope

Once the patient is under anaesthesia, the RIRS surgery team proceeds with the insertion of a flexible endoscope. This device is a thin, flexible tube equipped with a light and camera that allows the surgeon to see inside the urinary tract. The endoscope is gently guided through the urethra, into the bladder, and then manoeuvred up into the ureters—the tubes that connect the kidneys to the bladder. This step is crucial as it provides the visual access needed for precise stone management.

Stone Localization and Fragmentation

With the endoscope in place, the surgeon uses X-ray imaging to accurately locate the kidney stones. This imaging helps to confirm the stone’s size, shape, and exact location, guiding the next steps of the procedure. Once the stones are located, a laser fibre is introduced through the endoscope to the site of the stones. The laser is then used to fragment the stones into smaller pieces. This part of the procedure is critical as it uses high-energy laser pulses to break down the stones without causing significant damage to the surrounding tissues.

Stone Extraction

After the stones are fragmented into smaller, manageable pieces, the next step involves their removal:

• Stone Basket: A tiny, wire-basket device is passed through the endoscope. This basket is used to capture and collect the stone fragments.
• Extraction: The surgeon carefully retrieves the basket with the stone fragments, pulling them out through the ureter and bladder and finally out of the urethra.
• Verification: The surgeon may use X-ray imaging or the endoscope camera to ensure that all significant fragments have been successfully removed from the kidney and ureter.

This systematic approach not only ensures the effective removal of stones but also minimizes the risk of complications such as ureter damage or residual stone fragments, which could lead to further issues. The procedure’s minimally invasive nature contributes to a quicker recovery time compared to open surgery, with most patients being able to return to their normal activities within a few days.

Double J-Stunting in RIRS

• Pre-Surgery: Stents may be placed before the surgery to dilate the ureter.
• Post-Surgery: Stents are often placed to facilitate healing and maintain ureter integrity.

Preparing for RIRS Surgery

Proper preparation can significantly impact the success of the surgery and reduce the risk of complications:

• Medication Review: Inform your doctor about all medications and allergies.
• Lifestyle Adjustments: Stop smoking and adhere to dietary restrictions.
• Fasting: Fast for 8 to 9 hours before the procedure.

Post-Operative Care

The recovery period for RIRS is relatively short, and most patients resume normal activities quickly:

• Hydration: Increase water intake to help flush out any remaining stone fragments.
• Diet: Eat fibre-rich foods and avoid spicy or high-protein foods initially.
• Activity: Avoid heavy exercise, but stay moderately active.

Benefits of RIRS Surgery

• Minimally Invasive: No cuts or stitches are involved.
• Quick Recovery: Patients typically return to normal activities within a few days.
• Low Morbidity: The procedure is safe with a very low risk of complications.
• Preservation of Renal Tissue: No harm is done to the renal tissues.

RIRS Surgery in Urology

RIRS is a pivotal development in the field of urology, offering a safer alternative to open surgery for kidney stone removal. It is particularly useful for patients who are not candidates for other forms of stone removal, such as shock wave lithotripsy.

Comparison with Other Treatments

RIRS vs. Other Kidney Stone Treatments:

• Shock Wave Lithotripsy (SWL): RIRS is more direct and can handle stones that SWL may not effectively treat, especially in complex cases.
• Open Surgery: RIRS offers a significantly faster recovery with fewer complications.

Choosing RIRS for Kidney Stones

• Patient Suitability: Ideal for patients with stones that are difficult to manage with non-invasive treatments.
• Stone Size and Location: Particularly effective for stones located within the kidney.

Conclusion

Retrograde Intrarenal Surgery (RIRS) represents a significant advancement in the treatment of kidney stones. Under the expert guidance of Dr Dushyant Pawar, this technique marries the effectiveness of traditional stone removal methods with the advantages of minimally invasive surgery. As medical technology progresses, RIRS continues to stand at the forefront of urological innovations, offering patients a safe, effective, and minimally painful option for kidney stone treatment.