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RIRS: Retrograde Intrarenal Surgery

RIRS or Retrograde Intrarenal Surgery is an endoscopic surgery performed to remove renal stones by reaching the kidney from the ureter. It is a very effective method to treat or manage urinary stones. Urinary stones are solid masses made of crystals which usually develop in the kidneys, though they can develop anywhere along the urinary tract – kidney, ureter, bladder and urethra. Depending on the location of the stone, the stones are referred to kidney stone, ureteral stone or bladder stone. Also, varying by the location of the stone, the process of stone formation is called urolithiasis, renal lithiasis or nephrolithiasis. These stones are formed due to excessive accumulation of certain minerals in the body and the lack of fluids to dissolve the accumulated minerals that can include calcium, oxalate and uric acid. Moreover, other factors such as poor diet, severe diarrhoea, excessive weight, family history or certain medications can also lead to the formation of stones along the urinary tract.

Procedure of RIRS

Before the procedure,the doctor will conduct to determine the position of the stones, the general health condition of the patient and the overall response to anaesthesia. These assessments will be made at least 2 weeks before scheduling a retrograde intrarenal surgery.Once, the tests are clear, the doctor will conduct the stenting process 2-weeks before the actual RIRS surgery.The stenting is done to allow easier access to the urteroscope to enter the kidneys, as the stents since ureteroscopy is already dilated. Moreover, on the day of the surgery, the patient is required to not eat or drink anything for at least 4-6 hours. 

To begin the surgery, the patient is given anaesthesia and the urologist uses an endoscope – a thin, flexible tube – toreach thebladder through the urethra. Once there, the endoscope is then further directed to the area of urine storage in the kidney.

In the RIRS procedure, the surgeon 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. Post the procedure, the endoscope is crushed, blasted or evaporated 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. 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.

Purpose of RIRS

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 ureterorenoscopes and lithotripters including holmium laser, ensuring no trace of stones are left. Moreover, advancement in related equipment such as guide-wires, urethral 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. 

Suitability of RIRS

An RIRS procedure is best suited for cases where:

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

Advantages of RIRS

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 RIRS

Complications or risks associated with RIRS are fairly uncommon and occur only in very 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, especially along the previous tubes or after urinary tract infections. Such cases are not the ideal situations for RIRS and can be treated better through a different method.

Overall, RIRS has established itself as a reliable and safe method of treatment for renal stones. The advantages of RIRS outweigh its disadvantages. It is a very feasible treatment option with high success rates and lower complications involved. However, the suitability of RIRS for a patient can be determined by medical professional only.

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