RIRS- Intra Corporeal Lasers

Retrograde Intra- renal Surgery (RIRS) is a surgical procedure used to remove a small tumor or stone which cannot be removed by ESWL or is in a complex position within the kidney.A genereal/ spinal anesthesia is sued and it is an out- patient procedure.

Safety :

Very safe, speedy recovery and relives prolonged pain.

Length Of The Surgery :

1 – 3 hours.

Diagnosis :

  • RIRS- Intra Corporeal Lasers is recommended after the following diagnosis tests.
  • Physical exam
  • Medical history.
  • X-ray.
  • CT scan.
  • Ultrasound.
  • MSU- Mid stream urine test.

Treatment :

  • RIRS is used to treat the following complex conditions.
  • Concomitant renal/ ureteric stones.
  • Pediatric stones.
  • Radiolucent stones
  • Nephrocalcinosis
  • Infundibular stenosis.
  • Large stones for which ESWL is not the right treatment.
  • Previous failed treatments.
  • Bleeding disorders.
  • Gross obesity.
  • Tumors/ Strictures.

Preparation :

  • Certain medications to be specifically avoided pre surgery:
  • Avoid drinking/ eating 6 hours prior.
  • Avoid blood thinning agents like clopidogrel/ aspirin/ warfarin.
  • Avoid anti inflammatory, non- steroidals 7 to 10 days prior.
  • Ensure sterile urine by a MSU- mid stream urine test.

Procedure :

  • First and foremost, a wire as a safety guide is placed up the renal pelvis.
  • Ureteric dilatation is performed and an access sheath is placed at the required location.
  • After this, with the help of a fibre optic endoscope/ fluoroscope guidance, ureterorenoscope which is flexible is inserted over the safety guide wire, up the renal pelvis.
  • Saline irrigation takes place to identify endoscopic pathology for the detailed inspection Systematic inspection of the pelvi- calyceal system.
  • RP/ fluoroscopy are used if required.
  • With Intra corporeal laser, lithotripsy is performed.
  • Endoscopy/ fluoroscopy help to directly assess the stone.
  • The stone is evaporated with intra corporeal lasers orfragmented with ultrasound.
  • The stone is then either retrieved by grabbing with small forceps.
  • If that is not possible, the stone is relocated from where it can be naturally passed out.
  • Placement of double-J ureteric catheter as indicated.

Risks :

The RIRS potential risks include:

  • More invasive as compared to ESWL.
  • There is a minor risk of ureter damage is 0.5%.
  • 0.5 % risk perforated ureter.
  • Infection.
  • Bleeding with urine passage.

Post Surgery symptoms :

  • Frequent urination.
  • Occurence of blood.
  • Stinging/ burning sensation.

Follow-up :

It’s usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms that suggest there could be a problem, such as:

  • 24 hour surveillance.
  • Increase water intake to 2.5 litres/ day ie 8 glasses.
    Visit doctor:
  • Removal of stent 2 3 weeks after surgery.
    Emergency Follow up:
  • Worsening pain .
  • Large amounts of blood clots in the urine.
  • Difficult/ painful voiding and fully emptying the bladder.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.