Kidney stones are hard mineral deposits that develop inside the urinary system. Some remain unnoticed, while others cause severe flank pain, nausea, blood in the urine, urinary obstruction, or infection. Small stones may pass naturally, but larger or complicated stones may require a procedure.
RIRS surgery offers an incision-free option for treating selected kidney stones. A flexible instrument reaches the kidney through the natural urinary passage, allowing the surgeon to locate and fragment the stone with laser energy.
Consulting a trusted urologist in Ahmedabad at SGVP Holistic Hospital can help patients understand whether RIRS is suitable for their condition. Imaging findings must be considered alongside symptoms, kidney function, infection risk, urinary anatomy, and previous treatment.
What is RIRS Surgery?
Retrograde intrarenal surgery, or RIRS, is a minimally invasive procedure used to treat kidney stones without making an external skin incision. The surgeon reaches the kidney by passing a flexible ureteroscope through the urethra, bladder, and ureter.
During the procedure:
- The patient receives anaesthesia to prevent pain and movement.
- A thin, flexible ureteroscope is passed through the urinary passage.
- The surgeon guides the instrument into the affected kidney.
- A camera helps identify stones inside the renal collecting system.
- Laser energy breaks the stones into dust or smaller fragments.
- Selected fragments may be removed using a small retrieval basket.
- A temporary ureteral stent may be inserted to support urine drainage.
RIRS is frequently described as scarless because it does not require an external surgical cut. However, it remains an operative procedure that requires anaesthesia, sterile precautions, and postoperative monitoring.
When is RIRS Recommended for Kidney Stones?
RIRS may be recommended when a kidney stone is unlikely to pass naturally or is causing persistent symptoms. The decision depends on the stone’s size, position, composition, associated complications, and the patient’s overall health.
A specialist may consider RIRS for:
- Stones located within the kidney
- Persistent pain despite appropriate medication
- Stones causing urinary obstruction
- Recurrent blood in the urine
- Multiple stones within the kidney
- Stones that remain after shock-wave lithotripsy
- Stones that are difficult to target using shock waves
- Selected patients who may not be suitable for PCNL
- Recurrent stones requiring active removal
- Stones associated with repeated urinary infections after infection control
RIRS may not be the preferred option for every patient. Large stones, branching staghorn stones, or a heavy stone burden may require PCNL, more than one RIRS session, or another planned approach.
Tests and Preparation Before RIRS
Patients require a detailed evaluation before RIRS to confirm the diagnosis and reduce avoidable procedural risks. The assessment also helps the urologist determine whether another stone treatment would offer better clearance.
Preparation may include:
- Imaging: A CT scan, ultrasound, or X-ray helps identify the stone’s size, location, density, and number.
- Urine examination: A routine urine test and urine culture help detect urinary infection.
- Blood tests: These assess kidney function, haemoglobin, blood sugar, clotting, and other relevant parameters.
- Medication review: Blood thinners and certain medicines may require adjustment under medical supervision.
- Anaesthesia assessment: The anaesthesia team reviews existing illnesses, previous reactions, and operative fitness.
- Infection treatment: An active urinary infection generally requires treatment before definitive stone surgery.
- Fasting instructions: Patients receive clear instructions about eating, drinking, and regular medicines before admission.
Some patients may need a ureteral stent before RIRS. This may be considered when the ureter is narrow, the kidney requires urgent drainage, or infection and obstruction must be controlled before stone removal.
Patients should not stop prescribed medicines independently. Any changes to anticoagulants, diabetes medicines, or blood pressure treatment must follow instructions from the treating team.
How is RIRS Surgery Performed?
RIRS is performed through the natural urinary passage using a flexible ureteroscope and laser system. No incision is made on the abdomen or back, although internal instruments and a temporary stent may still be required.
The procedure generally follows these steps:
- Anaesthesia is administered: RIRS is usually performed under general anaesthesia, depending on the patient’s clinical condition.
- The urinary passage is accessed: The surgeon passes an endoscopic instrument through the urethra and bladder towards the ureter.
- The kidney is reached: A flexible ureteroscope is carefully guided through the ureter into the kidney.
- The stone is identified: The camera allows direct visualisation of the kidney’s internal collecting system.
- Laser fragmentation begins: Laser energy breaks the stone into fine dust or smaller pieces.
- Fragments are managed: Fine particles may pass naturally in urine, while larger fragments can be removed using a basket.
- Drainage is assessed: A temporary ureteral stent may be inserted when swelling, stone fragments, or procedural findings could interfere with urine flow.
SGVP Holistic Hospital has a thulium fibre laser system for RIRS procedures within its multispeciality setup. TFL technology can be used to dust or fragment urinary stones while the surgeon directly observes the treatment area.
The amount of stone cleared in one session varies. Patients with multiple, large, hard, or unusually positioned stones may require a staged procedure rather than prolonged treatment during a single sitting.
What Are the Benefits and Limitations of RIRS?
RIRS avoids an external incision and allows the surgeon to view stones directly inside the kidney. However, the procedure does not guarantee complete clearance in one session and may not suit every type of kidney stone.
| Potential benefits | Important limitations |
| No external surgical incision | Not suitable for every stone burden |
| Direct visualisation of kidney stones | Large stones may require staged treatment |
| Laser dusting or fragmentation | Small residual fragments may remain |
| Lower wound-related burden | Temporary stent discomfort can occur |
| Access to stones in different kidney locations | Difficult anatomy may limit access |
| Usually faster recovery than open surgery | Another procedure may occasionally be needed |
Recognised risks include:
- Temporary blood in the urine
- Burning or discomfort during urination
- Urinary urgency or frequency
- Flank discomfort related to a stent
- Urinary tract infection
- Fever or sepsis in uncommon cases
- Injury or narrowing of the ureter
- Incomplete stone clearance
- Movement of fragments into difficult locations
- Need for repeat RIRS, stenting, or another procedure
A change in the treatment plan does not automatically mean that the operation has failed. Surgeons may stop or stage the procedure when swelling, infection risk, poor visibility, difficult anatomy, or procedural duration makes continuing less safe.
What is Recovery Like After RIRS Surgery?
Recovery after RIRS is usually quicker than after incision-based kidney stone surgery. The timeline varies depending on stone size, procedure complexity, stent placement, infection, and the patient’s overall health.
During early recovery, patients may experience:
- Mild burning during urination
- Increased urinary frequency
- Light blood staining in urine
- Mild flank or abdominal discomfort
- Temporary stent-related urgency
- Tiredness after anaesthesia
Patients should take prescribed medicines, drink fluids as advised, avoid strenuous activity, and attend follow-up or stent-removal appointments.
Seek immediate medical help for:
- Fever or chills
- Increasing pain
- Inability to urinate
- Persistent vomiting
- Heavy bleeding or blood clots
- Severe weakness or breathlessness
These symptoms may indicate infection, obstruction, or another complication requiring assessment.
Can Kidney Stones Return After RIRS?
RIRS removes or fragments existing stones, but it does not remove the underlying tendency to form them. Recurrence prevention depends on stone analysis, urine findings, metabolic risk factors, diet, fluid intake, medicines, and associated health conditions.
Preventive measures may include:
- Drinking an individually appropriate amount of water
- Reducing excessive dietary salt
- Avoiding unnecessary calcium supplements
- Maintaining normal dietary calcium unless advised otherwise
- Moderating excessive animal protein intake
- Managing obesity, diabetes, or metabolic disorders
- Completing stone composition analysis
- Undergoing metabolic evaluation for recurrent stones
- Taking preventive medicines when prescribed
- Attending periodic imaging follow-up
Patients should avoid assuming that all kidney stones require the same diet. Calcium oxalate, uric acid, struvite, cystine, and other stones have different causes and preventive strategies.
Urological Care at SGVP Holistic Hospital
SGVP Holistic Hospital provides diagnostic and procedural care for kidney stones and other urinary conditions. Treatment planning considers symptoms, imaging, kidney function, anaesthetic risk, infection status, and the complexity of the condition.
Urology Department at SGVP Holistic Hospital provides care for:
- Kidney and ureteric stones
- Urinary obstruction
- Recurrent urinary infections requiring urological evaluation
- Prostate enlargement
- Prostate cancer
- Urinary bladder conditions
- Male urinary and reproductive concerns
- Selected complex and high-risk kidney problems
- Minimally invasive urological procedures
- RIRS using a TFL laser system
The hospital’s urologists involved offer prompt assessment and treatment of various urological conditions. Dr Ravi Jain, Consultant Urologist at SGVP Holistic Hospital, is associated with the management of kidney stone disease and minimally invasive procedures, including laser-based stone treatment and RIRS.
SGVP Holistic Hospital is an NABH-accredited, approximately 200-bed multispeciality hospital in Ahmedabad. It follows an ethical and quality-focused approach while working to keep treatment accessible.
Conclusion
RIRS surgery is an incision-free treatment for selected kidney stones that cannot pass naturally or are causing pain, obstruction, bleeding, or infection. The procedure uses a flexible ureteroscope and laser energy to reach and fragment stones inside the kidney.
Not every stone requires RIRS. Treatment depends on stone size, position, number, urinary anatomy, infection status, kidney function, and overall health. Larger or complex stones may require PCNL or staged procedures.
Patients with severe pain, fever, urinary difficulty, or blood in the urine should seek medical assessment. SGVP Holistic Hospital provides evaluation and minimally invasive treatment planning for kidney stone conditions.
Frequently Asked Questions
Yes, RIRS (Retrograde Intrarenal Surgery) is considered completely scarless externally. The surgeon passes a thin, flexible scope through your natural urinary path (the urethra and bladder) to reach the kidney, meaning no external cuts, holes, or stitches are made on your skin.
RIRS can treat kidney stones of different sizes, but suitability cannot be decided by diameter alone. The urologist also considers stone number, location, hardness, kidney anatomy, infection risk, previous treatment, and expected clearance.
No, Retrograde Intrarenal Surgery (RIRS) is not painful during the procedure because it is performed under general or spinal anesthesia. After the surgery, you may feel mild to moderate discomfort as the anesthesia wears off, but doctors can easily manage this with prescribed painkillers.
Many patients resume light activities within several days, although recovery varies. Stone burden, anaesthesia, infection, stent placement, occupation, and procedural complexity can affect the timeline. Strenuous activity should wait until the treating doctor provides clearance.
Kidney stones can return because RIRS treats existing stones rather than the underlying cause. Stone analysis, adequate fluid intake, dietary changes, metabolic testing, prescribed medicines, and follow-up imaging may help reduce the risk of recurrence.
Consult a urologist for persistent flank pain, repeated stones, urinary obstruction, blood in the urine, recurrent infections, or difficulty passing urine. Fever with stone symptoms requires urgent assessment because infection behind an obstruction can become serious.
