RIRS/ Retrograde Intrarenal Surgery
For kidney patients having small to medium sized kidney stones, a revolutionary surgical technique for kidney stone removal is being popularly recommended by urologists in Hyderabad- the Retrograde intrarenal surgery (RIRS).
The doctors and kidney stone experts in Hyderabad at Arete Hospitals have extensive experience in performing RIRS procedure. Arete Hospitals is known as the best kidney stone removal hospital in Hyderabad, Telangana. It houses an advanced operation theatre equipped with top-notch 3D HD laser, laparoscopic equipment, and AI surgical robotic system to perform RIRS procedure. It is known to deliver successful surgical outcomes and keep the patient’s safety and comfort at a top priority.
Benefits of RIRS
RIRS is a minimally invasive operation, the best among all kidney stone removal procedures, to treat challenging cases with ease. The best part of this technique is that there is no need of making any skin incisions and still the surgery is performed inside the kidney by moving up and through the urethra with the surgical instrument using fluoroscopy. Other advantages of RIRS are:
- The rate of kidney stone removal is very high among the patients.
- There is safe kidney stone removal.
- As the surgery is minimally-invasive, the procedure is associated with minimal risk and quick recovery.
- The surgery is not time-taking and there is minimum hospitalisation (from a few hours to a day) needed.
- The operation does not cause any damage to renal tissues.
- In a single sitting, the patient can get rid of kidney stones. However, more than one treatment session would be required for removal of hard and brittle stones.
- The surgery has minimal to no postoperative complications. Unlike PCNL surgery, the possibility of developing sepsis is not seen and having a drop in haemoglobin level is very less after the surgery.
What is RIRS?
RIRS is a minimally invasive kidney stone removal technique for kidney stones treatment in Hyderabad. It is the method involving the passing of a fiberoptic endoscope through urethra to the kidney to view and operate the inside of the kidney. This fibre-optic tube is flexible and so can easily bend with the renal system and pass through the ureter and kidneys. The tube is moved into the part of the renal pelvis to help visualise the different kidney parts. Further, a thin, holmium laser fibre is passed through the endoscope to fragment the kidney stones into powdered form with thermal energy. This makes it easier for the kidney stones to be flushed out of the system with urine or else through saline irrigation.
Before RIRS Surgery
RIRS Surgery in Hyderabad is only recommended and performed on the patients after they undergo the following tests before their operation.
- Pre-surgical fitness test from the anaesthetist.
- A blood and urine test to ensure their stable health.
- An X-ray imaging test of the Kidneys, Ureter, and Urinary Bladder to check for stones and locate them.
Before the RIRS procedure, the urologist typically provides the following pre-operative instructions to assist the patient in getting ready for the RIRS surgery:
- Avoid intake of blood thinners as it can lead to difficulty in clotting of blood during and after surgery. Inform the doctor about current intake of medications/supplements as well as medical conditions.
- Give up on smoking.
- Let the doctor know if having any allergies to anaesthesia. The doctor takes into account the patient's preferences for the type of anaesthesia to be used before the surgery.
- On the day of the surgery, wear loose, comfortable garments. Avoid eating or drinking anything for 6-8 hours beforehand.
What does RIRS Surgery involve?
RIRS procedure
The RIRS procedure lasts for around 1-2 hours. This operation is carried out under spinal or general anaesthesia to ensure no discomfort during the procedure.
In this incision less surgery, the kidney stone surgeon in Hyderabad first places a stent in the urethra to prevent the collapse of walls of ureter. For some patients, a pre-operative DJ stenting may be done 2 weeks prior to the operation. This is important to dilate the ureter and make it easy for the urethroscope to get inside the kidneys and access the portion of the kidneys that produce urine.
Once the anaesthesia takes effect, the doctor inserts an endoscope- a flexible, long digital fibre optic tube, into the urethral canal to the ureter. To precisely place the endoscope, the doctor even uses X-rays and image screening to see real time pictures of the inside of the kidneys on an external screen. The insertion of the endoscope is done in a retrograde manner- in the direction of the kidneys.
After locating/detecting the stones, the doctor makes use of forceps to completely remove the stones or holmium laser to shatter the stones into smaller pieces without harming the surrounding organs. These pieces of kidney stones are collected in a stone basket which is later taken out after the doctor confirms that all kidney stones have been recovered. The surgery ends with removal of the endoscope and draining out of excess fluids from the kidney. The doctor may insert a urinary catheter into the urethra to reduce discomfort and difficulty in urinating. This remains for 8 to 24 hours after surgery.
Good Candidates for RIRS
The people who can get benefit from RIRS include:
- Patients with small to medium sized kidney or ureteral stones up to a diameter of 2cm, non-opaque and hard stones, or multiple stones including the nephrocalcinosis- increased calcium levels in the kidneys.
- Patients who are resistant to extracorporeal shockwave lithotripsy or any other kidney removal procedures.
- Children having kidney stones.
- Patients having bleeding disorders in the kidneys.
- Patients with unusual structures or tumours in the kidney.
- Patients with anatomical abnormalities such as a narrow infundibulum, long lower pole calyx, and acute IPA.
- Kidney stone patients with gross obesity.
Suitable candidates are otherwise healthy people without any serious heart or lung conditions and active urinary infections.
After Discharge
The patient must follow the post-operative instructions given by the doctor. They must:
- Consume plenty of fluids to sustain urine production and prevent infections.
- Go for a follow-up visit with the primary care physician to check on their progress of recovery.
- Take proper rest. Gradually step-up level of physical activity. Do not indulge in strenuous activities while the urine passed has a bloody tint.
- Make sure to have a nutritious diet which is rich in fibre.
- Avoid or limit alcohol consumption or intake of caffeinated beverages.
- Take prescribed antibiotics to prevent infections and painkillers to alleviate any discomfort.
Cost of RIRS Surgery in Hyderabad
The average cost of RIRS surgery in Hyderabad is determined by various factors such as:
- the surgeon’s expertise
- the cost of diagnostic tests
- the number of kidney stones
- the cost of stents (if used)
- the cost of consultation of the urologist
- the specific patient requirements-like hospital stay (if needed)
- insurance coverage.
As RIRS is a medical procedure and so its cost is covered by most medical/health insurances. However, the patients having deductibles and coinsurance policies will have to pay from their pockets. Our expert team at Arete hospitals will verify the insurance claims before starting with the surgery. In case the patients have no insurance in their names, our specialists will provide the cost estimate for RIRS surgery during initial consultation.
Effectiveness of RIRS Surgery in Hyderabad
RIRS is best for management of renal and ureter stones in between 10-14 mm. With this surgery, there is a high rate of elimination of stones. Patients have reported RIRS to be an effective kidney stones removal option with minimal complications and more effective preservation of renal parenchymal functions, as compared to PCNL surgery.
Risks Associated with RIRS
The risks and side effects from RIRS procedure are very rare and uncommon. Few patients may experience:
- Ureter avulsion
- Fever
- Infection of urinary tract
- Bleeding
- Sepsis
- Acute urinary incontinence
- Momentary haematuria
- Flank pain
- Fornix rupture.
1. How long is the recovery from the RIRS procedure?
The patient generally can expect a recovery time of 24- 48 hours after surgery, followed by proper, full rest. During recovery, the patient must follow the surgeon’s instructions.
2. Is RIRS safe?
RIRS is a safe operation if performed by a highly qualified and experienced urologist. The procedure's safety also depends upon the procedure indications, the set-up, and the surgical team. At Arete Hospitals, we have an expert team of urologists with decades of experience in RIRS procedures.
3. Are there any food restrictions just after my RIRS procedure?
Yes. To avoid the recurrence of kidney stones, you must have a healthy diet containing less sodium, animal proteins, oxalate, and more calcium.
4. How long does the blood in the urine show up after the RIRS procedure?
If the patient has a urethral stent, it’s normal to expect spotting of a small amount of blood in the urine for up to a week and 3-4 days if having no stent. In case of heavy bleeding or the formation of blood clots, the patient must immediately report it to a urologist.
If one is suffering from discomfort in their flank region and suspect the presence of kidney stones, then they should consider scheduling an appointment with a kidney stone specialist in Hyderabad at Arete Hospitals.
Arete Hospitals consists of board-certified urologists with extensive training in identifying and delivering optimal treatment solutions for kidney stone removal. With any surgical procedure, there might be minimal risks or complications involved. Arete Hospitals is equipped with state-of-the-art medical facilities and has skilled professionals to effectively address and manage any potential issues or risks associated with the procedure. Many patients who have chosen Arete Hospitals for their treatment experienced a trouble-free stay and a rapid recovery process. Feel free to reach out to Arete Hospitals to consult with their experienced urologists in Hyderabad for kidney stone removal with RIRS.
