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.
Very safe, speedy recovery and relives prolonged pain.
Length Of The Surgery :
1 – 3 hours.
- RIRS- Intra Corporeal Lasers is recommended after the following diagnosis tests.
- Physical exam
- Medical history.
- CT scan.
- MSU- Mid stream urine test.
- RIRS is used to treat the following complex conditions.
- Concomitant renal/ ureteric stones.
- Pediatric stones.
- Radiolucent stones
- Infundibular stenosis.
- Large stones for which ESWL is not the right treatment.
- Previous failed treatments.
- Bleeding disorders.
- Gross obesity.
- Tumors/ Strictures.
- 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.
- 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.
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.
- Bleeding with urine passage.
Post Surgery symptoms :
- Frequent urination.
- Occurence of blood.
- Stinging/ burning sensation.
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.
- 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.