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What is RIRS?
Retrograde Intrarenal Surgery (RIRS) is surgery to remove intrarenal stones using a viewing tube known as a fiberoptic endoscope. The minimally invasive procedure allows surgeons to visualise the complete renal collecting system. The surgery is associated with fewer complications, shorter hospitalisation, less morbidity, and an earlier return to work.
What are Benefits of RIRS?
RIRS offers several advantages, which include:-
- Minimally invasive
- Simple and quick procedure
- Less painful
- Shorter recovery time
- Minimal bleeding
- Less risk of damage to the renal tissue
- Fewer inconveniences
Who needs RIRS?
Your doctor may recommend a retrograde intrarenal surgery in the following cases:-
- Failure in other treatment methods
- Large kidney stones (more than 20 mm in diameter)
- Tumour in the kidney
- Strictures in the kidney
- Kidney stones in children
- Bleeding disorders in the kidneys
- Grossly obese patients
How is RIRS done?
- The surgeon will insert a Dj stent in the affected kidney two weeks before the surgery to prevent the walls of the ureter from collapsing.
- On the day of the surgery, the surgeon will insert a fiberoptic endoscope, a thin, flexible tube, through the urethra into the urine collecting part of the kidney.
- The endoscope has a small camera fitted at the end to spot kidney stones.
- Once the stones are spotted, the surgeon uses a Holmium laser to manipulate or crush the stones.
- All the stone fragments will be gathered in a stone basket and removed from the body.
- The surgeon will remove the endoscope and drain the kidney of excess fluid.
- RIRS is an intrarenal procedure that requires no incisions.
- The surgery can take about 1 to 2 hours.
What Can You Expect Before the Surgery?
- The doctor will advise you for a pre-anaesthetic checkup.
- He/she will ask you about your medical history and conduct preoperative tests such as abdomen ultrasound and other imaging tests, including an X-ray, CT scan or MRI.
- Your medical team will ask you to fast for at least six hours before the surgery.
- The doctor will also perform preoperative Dj stenting two weeks prior to the surgery.
- Inform your provider about the prescribed and over-the-counter medications you take.
- The doctor will briefly explain the procedure, duration, estimated cost, and insurance formalities.
- You may ask your questions regarding the surgery.
What Can You Expect on the Day of the Surgery?
- You will be asked to sign the consent formalities, giving your permission for the procedure.
- The hospital team will ask you to change into a hospital gown and remove all jewellery pieces.
- Someone from the nursing team will shave excess hair from the insertion site of the endoscope.
- The doctor will record your last meal.
- The anaesthesiologist will monitor your vitals, including heart rate, blood pressure, and breathing.
- The team will shift you to the OT room.
What Can You Expect During the Surgery?
- In the OT room, you will be made to relax on the operating table in the dorsal lithotomy position (lying on your back with legs flexed 90 degrees at your hip and knees bent at 70 to 90 degrees).
- The team will start an intravenous (IV) line for fluids and medications in your arms or hands.
- The procedure will be performed under general or spinal anaesthesia.
- Throughout the procedure, the anaesthesiologist will monitor your vitals, such as heart rate, breathing, and blood pressure.
- The surgeon will perform the final surgical procedure.
What is Recovery and Post Op. Care After RIRS?
In the Hospital:-
After the procedure, the team will move you to the recovery room, where the doctor will monitor your condition closely.
A urine catheter will be put into the urethra, usually for a day, to minimise pain and difficulty while urinating.
Your doctor will advise bed rest for 24 hours after the surgery.
However, if you are fit to continue regular exercises, you may be discharged from the hospital the day after the surgery.
Before discharge, the doctor will provide home care and follow-up instructions.
Ensure eating a fibre-rich diet after the surgery. Avoid eating food that may lead to constipation, causing too much strain during bowel movements.
Keep the wound area clean and dry.
Drink around 8-10 litres of water per day to keep infections at bay.
The doctor may prescribe pain killers and mild laxatives.
Reduce alcohol intake and consumption of caffeinated beverages.
Avoid engaging in strenuous activities and lifting heavy weights for at least a month after the surgery.
First Follow-Up Appointment
Attending follow-up sessions with your doctor is crucial for examining the success of the surgery. Your doctor will schedule the first follow-up appointment 5-7 days after the surgery. During the visit, the doctor will make sure that the stones are completely cleared from the body.
What are Risks and Complications of RIRS?
The risk of complications after retrograde intrarenal surgery is rare. These risks include:-
- Flank pain (pain in the upper abdomen, back, or sides)
- Transient hematuria
- Urinary tract infection
- Kidney loss
- Urinary disease
- Ureter separation
Call your healthcare professional if you experience:-
- Severe pain while passing urine
- Unable to pass urine
- Worsening bleeding