RIRS

What is RIRS surgery, and what is its purpose?

RIRS Full form in medicine – retrograde intrarenal surgery.

RIRS is a minimally invasive treatment for removing kidney stones; during surgery, a fiberoptic endoscope is introduced through the kidney. Because the fibre-optic is flexible, it may easily bend and penetrate the renal system, including the kidney and ureter.

The tube is put into the ureter, the portion of the kidney that collects urine, and it aids in the viewing of numerous kidney components. The thin laser fiber is then pushed through the scope, breaking down stones into very small particles that may be easily removed with urine or saline treatment.

The nicest part of the surgery is that there is no need for an incision, and the patient is given general / local anesthesia. The urologist will carry out the surgery to ensure that you get the finest possible treatment.

What is the purpose or indication of RIRS surgery?

RIRS (Retrograde intrarenal surgery) is a retrograde ureteroscopic method that is carried out inside the kidney without the need for any exterior holes or incisions. Fluoroscopy, or live X-ray, is used to push the device up through the urethra and into the kidney. The procedure is minimally invasive, making it ideal for addressing challenging problems. The following are some indications for RIRS surgery:

Kidney stones are too big for lithotripsy.
Kidney stones in youngsters.
Strictures in the kidney
Kidney bleeding diseases.
Failures with other treatments
Obese individuals may have RIRS surgery or DJ stenting.

DJ stent, also known as Double-J stent, is a urethral stent implanted in the ureter with a J shape curve at each end made of polyurethane to prevent the stent from slipping into the kidneys or bladder. DJ stents are often put before or after RIRS surgery to alleviate discomfort caused by kidney stones or infection.

Double-J stent implantation prior to RIRS surgery: In certain individuals, depending on their health, a DJ stent is put prior to surgery to widen the ureter and prepare the patient for surgery so that the flexible ureteroscope may easily pass through.
Double-J Stent Placement Following RIRS Surgery: Most patients have a DJ stent put for 7 to 14 days, which aids in healing and alleviates discomfort. Reinsertion of the DJ stent is not recommended in most situations.

Some typical complications of DJ stent insertion include an irritated bladder, blood in the urine, a urinary tract infection, lumbar and suprapubic pain, and stent sensitivity and discomfort. It is generally advisable to remove the DJ stent as soon as possible.

What to anticipate before undergoing RIRS surgery?

A retrograde intrarenal surgery (RIRS) is simpler, less invasive, and less prone to produce complications. Before surgery, the patient must undergo these examinations.

Blood test.

X-ray KUB (kidney, ureter, bladder)
Pre-operative fitness from the anaesthetist
Pre-operative DJ stunting : In certain cases, pre-operative DJ stenting is necessary two weeks before the treatment; this stenting permits the ureteroscope to access the kidneys more readily since the ureter is already dilated. Prior to surgery, patients are kept fasting for 6-8 hours.

What can you anticipate during a RIRS surgery?

The patient will be sedated with anesthesia, and the urologist will use a digital or fibre optic endoscope – a thin, flexible tube – to enter the bladder via the urethra and then into the kidney’s urine storage region. The endoscope will identify stones and blast them with a laser until golden sand is formed.

Furthermore, the DJ stent is to be inserted for 1 to 2 weeks before or after the RIRS operation to help smooth and speed up recovery; in most instances, patients are released the same day after surgery.

What to anticipate after RIRS surgery?

A urologist places a urinary catheter in the urethra to reduce discomfort and difficulties urinating; the catheter is remained in place for 8 to 24 hours. Following that, the patient will be sent to the recovery room for monitoring for 6 to 8 hours following surgery. The patient will be admitted to a hospital room and rest for at least 24 hours.

Furthermore, to prevent infection and sustain urine output, the patient must consume at least 3 liters of fluids every day. Furthermore, if the patient is in excellent condition and can resume regular activities the next day after surgery, he or she may be released. However, a follow-up with the primary care doctor is essential.

Depending on your circumstances, the urologist may give you extra advice after the procedure.

Benefits of RIRS Surgery

Retrograde intrarenal surgery (RIRS) is a novel and sophisticated approach of treating renal stones. Here are some of the advantages of the RIRS surgery:

Minimally invasive.
The operation is straightforward and fast.
Recovery time is decreased.
Less pain.
Less morbidity.
Very little bleeding.
Harmless to renal tissue.

Risk risks and complications of the RIRS procedure

RIRS surgery adverse effects are infrequent and occur in a tiny number of cases. These are some problems observed in relatively few people.

Fever
Flank pain
Urinary infection.
Transient haematuria.
Acute urinary retention.
Fornix rupture.
Urinary avulsion
Bleeding Sepsis

Frequently Asked Questions:

Is the RIRS procedure painful?

Patients may not experience discomfort during RIRS surgery since it is conducted under general anaesthesia. Patients may have some lower abdomen pain and discomfort after RIRS surgery, which usually resolves within 18 to 36 hours. Despite this, many people are afraid about having RIRS surgery, although the majority of them take it well and recover rapidly.

What’s the difference between URSL and RIRS?

URSL is mostly used for lower ureteric stones that are less than 10 – 15 mm. If the stone is larger than 15 mm, laparoscopic treatment is preferred. RIRS surgery is an endoscopic treatment that treats proximal ureteric or kidney stones. If a stone is less than 2 cm, RIRS surgery is done.

What’s the difference between PCNL and RIRS?

PCNL is the percutaneous procedure where the surgeon will puncture the calyceal systems of the kidney over the skin and approach the location of the stone. This is usually related to stones present in the kidney calyceal system. Though it is an endoscopic procedure, we approach from the skin aspects, so it is called percutaneous nephrolithotomy. This procedure is usually applicable to larger stones, whereas RIRS is a complete endoscopic surgery where it is applicable for pro

How long does RIRS surgery take?

RIRS surgery typically lasts 45 to 60 minutes, unless it is a repeat treatment or a complex patient’s condition, in which case it may take 90 to 120 minutes (1 and 1/2 hours to 2 hours).

Can massive kidney stones be removed with RIRS surgery?

No, big stones from the kidney cannot be removed with RIRS surgery; however, if the stone is less than 2 cm, RIRS surgery is recommended.

How long does blood show in the pee after RIRS surgery?

It is totally common to have a tiny quantity of blood in urine for up to 7 days if a urethral stent is inserted or 3 to 4 days if no stent is implanted; also, a person may observe pink, red, or brown colored pee.

If a person has significant bleeding or clots, they should immediately contact their primary care doctor or urologist.

Is there a dietary limit soon after RIRS surgery?

Yes, there is a dietary restriction following RIRS surgery; to avoid the recurrence of kidney stones, the patient must follow a balanced diet that includes limiting animal protein, reducing oxalate from meals, reducing salt intake, and getting the proper quantity of calcium from foods.

What happens if RIRS surgery doesn’t work?

In some cases, RIRS surgery may not work in the first setting due to technical issues; in such cases, the surgeon will perform staged RIRS in which a stent is inserted into the ureter and the patient must wait three weeks for the ureter to dilate or reach adequate caliber so that the scope can easily enter the ureter and even the kidney’s pelvicalyceal system.