Rirs Surgery: Purpose, Procedure, and Benefits and Side Effects

As the name implies, RIRS, or retrograde intrarenal surgery, involves removing kidney stones by entering the kidney from the ureter in the opposite direction—that is, retrogradely. During this minimally invasive technique, kidney stones are removed using a fiberoptic endoscope, which is a sort of viewing tube and holmium laser. The fiber-optic cable's flexibility allows it to bend smoothly inside the renal system and enter the kidney and ureter with ease.

The tube, which aids in the visibility of various kidney sections, is put into the ureter, the area of the kidney that collects urine. After passing the narrow laser fiber through the scope, the stones are broken down into incredibly small particles, making it easier to wash them out with urine or saline irrigation.

The urologist performs the procedure without any incision, however the patient is given local anesthesia or general anesthesia.

It itself is a subtype of Kidney stone removal surgery.

Renal stone removal with retrograde intrarenal surgery (RIRS) is a novel and cutting-edge procedure that is carried out with a ureteroscope.

RIRS has become a popular method to treat stubborn kidney stones that are non-responsive to shockwave lithotripsy and ureteroscopy because of less problems and a good rate of recovery.

The newest tools and equipment are used by kidney stone specialists during the procedure to ensure minimal post-surgery complications. The following are a few benefits of RIRS surgery:

• Minimally invasive surgery
• Simple and quick
• No cuts or incisions
• Faster recovery
• Less pain
• No scars
• Less morbidity
• Minimal complications
• High stone clearing probability
• Fewer chances of recurrence
• Very little or no bleeding
• No harm to the renal tissues.

Patients with kidney stones between 10mm and 14mm in size are advised to undergo RIRS surgery as this is the best course of action for the patients who have a stone load or if the size of the stone is less than 2 cm.

The procedure does not require any cuts or incisions and can help treat stones that are lodged in the ureter, urinary bladder, or upper, middle, or lower calyx of the kidneys. With a minimum of difficulties, RIRS removes stones using a ureteroscope and cutting-edge technology.

Patients who have a history of recurring stones or whose stones are too big to pass naturally might consider RIRS as a viable treatment option. Stones that are difficult to treat with drugs like diuretics typically respond well to RIRS in terms of pain alleviation.

Also, When shockwave lithotripsy and ureteroscopy are failed, RIRS for kidney stone removal is typically advisable. Here are some conditions that may need a Retrograde Intrarenal Surgery to treat kidney problems;

• Large kidney stones that cannot be removed by lithotripsy
• Kidney stones in children
• Strictures in the kidney
• Anatomically complex kidneys
• Bleeding disorders in the kidneys
• Failure of alternative therapies/ treatments
• Obese patients

RIRS surgeries typically take 45 to 60 minutes, unless the procedure needs to be redone or the patient's condition is more complicated, it then might further extend and could last for 1 and a half to 2 hours.

To prevent complications following surgery, it is crucial to speak with your doctor before beginning treatment if you are on any medications or have an ongoing medical condition. Also, patients over the age of 65 should speak with a urologist before undergoing RIRS for kidney stone removal.

If a urethral stent has been implanted, a small quantity of blood in the urine may remain there for up to 7 days; if there is no stent, it may be there for up to 3 to 4 days. Additionally, a person may detect pink, red, or brown urine.

A person should see their primary care physician or urologist right away if they experience excessive bleeding or blood clots.

Before the RIRS surgery, your doctor will typically provide you instructions to assist you get ready for the operation. Here are some tips to help you get ready for your RIRS surgery:

• Prior to the RIRS procedure, let your urologist know about any current drugs or medical conditions
• Stop taking blood thinners that can make it difficult for your blood to clot
• Wear loose-fitting clothing to prevent pain at the surgery site
• Prior to surgery, give up all forms of smoking
• Please let your doctor know if you have any allergies to anesthesia
• Before your procedure, avoid eating or drinking anything for 8 to 9 hours as this may cause the anesthesia's effects to wear off more slowly.

RIRS is a cutting-edge surgical procedure for treating difficult kidney stones. To guarantee there is no discomfort during the surgery, the doctor delivers spinal or general anesthetic prior to the treatment.

To pinpoint the exact location of the stone, the urologist conducts imaging tests. The ureteral channel is then examined using a tool known as a ureteroscope. The tool has a camera attached to one end, which helps the surgeon go inside the body to find stones or points of ureteral obstruction.

A retrograde intrarenal surgery (RIRS) is an easy, less invasive surgical procedure that involves less chances of complications and risks. The patient must go through these tests before surgery.

• Pre-operative fitness from the anesthetist
• Blood test
• X-ray KUB (Kidney, Ureter, Bladder)

In a few instances, pre-operative DJ stenting is needed two weeks prior to the procedure. Because the ureter is already dilated, this stenting makes it easier for the ureteroscope to enter the kidneys.

To access the portion of the kidneys that produce urine, the urologist administers spinal or general anesthetic prior to the procedure. The lower body is sedated via spinal anesthesia.

Patients who receive general anesthesia become unconscious or slip into deep sleep. The patient's preferences are typically taken into account when choosing anesthetic.

• Stent is placed to prevent ureter walls from collapsing
• Pre-operative DJ stenting is already there to dilate ureters, thus making it easier for the ureteroscope to enter the kidneys.
• Endoscope is inserted
• After anesthetic starts its effect a long, flexible digital fiber optic tube known as an endoscope is inserted into the urethral canal to the ureter. For utmost precision, the surgeon additionally uses x-rays and image screening to provide real-time images of the kidneys on an external screen. The endoscope is advanced retrogradely in the direction of the kidneys.
• Stones are targeted with forceps or holmium laser
• The surgeon may use forceps to remove the stones whole or use laser beams to shatter them into smaller pieces.
• In order to create golden sand, the endoscope will detect stones and laser-blast them. . The stone is targeted with an advanced holmium laser in order to break or move it without harming the nearby organs.
• Kidney stone fragments are collected in a basket ad removed
• The stone particles are then collected into a stone basket. The basket is taken out after the surgeon confirms that all of the stone particles have been recovered.
• Endoscope is removed and kidney is drained of any excess fluid
• After removing the stones, the endoscope is removed and excess fluid is drained out of the kidney.
• Smaller stones are generally simpler to break and evacuate from the body than larger stones, which may need 'additional space.' By expanding the ureteral tube to allow for easier stone movement, double J stents or ureteral stents are used to solve this issue.
• The DJ stent should be implanted for 1 to 2 weeks prior to or following the RIRS operation to help flush out the stones from the body. Patients are often released the day after surgery in most circumstances.

• To ease discomfort and difficulty urinating, a urologist inserts a urinary catheter into the urethra; the catheter remains in place for 8 to 24 hours
• The patient will then be moved to the recovery room for observation for the next 6 to 8 hours following the operation
• Your vital signs and breathing will be observed by nurses. Depending on the surgery you had, you will either be transferred to a ward or given the go-ahead to return home once you are stable
• A hospital room will be provided for the patient to stay in for at least 24 hours
• In addition, the patient needs to consume a lot of fluids—at least 3 liters per day—to prevent infections and sustain urine production
• Additionally, if the patient is in good health and is able to return to their regular activities the day after surgery, they may be allowed to leave the hospital
• You will need someone to pick you up if you return home the day of surgery because you won't be able to drive. You'll also need someone to be with you for the first 24 hours if you have a general anesthetic
• A follow-up appointment with the primary care physician is crucial.

In India, Retrograde Intrarenal Surgery (RIRS) costs typically start at Rs. 80,000 and can reach Rs. 1 lakh depending on a number of factors.

A lot of variables may affect the cost of surgery. Along with tier-1 or tier-2 cities; hospital or clinic brand names, the fees of the treating consultant, admission fee, number of stones, post-surgical complications that are involved, admission room that you opted for, may have an influence on hospital billing expenses.

Here are some factors that typically impact the RIRS procedure's overall cost:

• Consultation cost of the urologist
• Selection of hospital
• Cost of diagnostic tests
• Medication cost
• Number of stones
• Cost of stents (if used)
• Hospital stay (if required)
• Insurance coverage.

Following RIRS surgery, patients are required to follow a diet that is low in animal protein, low in oxalate, low in sodium, and high in the proper kind of calcium.

This is done to prevent the recurrence of kidney stones. Also, make sure to continue eating well. It ought to include a lot of foods high in fiber. Eat less of the foods that make you constipated and make your bowel movements too difficult.

Here are some foods that needed to be included in your diet post RIRS surgery;

• Whole grain bread
• Beans
• Fresh vegetables
• Lentils
• Fruits
• Tofu
• Peas
• Diluted dairy products
• Orange juice

These are general dietary recommendations that will make it easier for you to handle the post-surgery stone removal care. Nevertheless, particular requirements may vary from patient to patient.

Therefore, it is advised to receive the instructions from a doctor who will consider the details of the situation.

When carried out by a qualified urologist, RIRS surgery is a safe procedure. It also depends on the setup, team of professionals, and the procedure's indications. At Pristyn care, we have a team of the best urologists who have extensive experience in performing RIRS Surgery.

Due to the local/general anesthesia used during RIRS surgery, patients may not experience any pain. However, once the effects of the anesthetic wear off, there can be some discomfort following the procedure from the stent implantation.

Patients who undergo RIRS surgery may experience mild lower abdomen discomfort and pain, which passes in 18 to 36 hours. Despite the fact that many people are afraid of having RIRS surgery, most people manage it well with over-the-counter painkillers and recover rapidly.

Recovery after RIRS surgery typically requires 24 to 48 hours, followed by a period of complete rest. To maintain urine production, patients must consume sufficient amounts of water. The doctor's prescription must be taken exactly as prescribed by the patient.

Side effects from RIRS surgery are very rare and uncommon. The following side-effects have only been seen in very few patients:

• Fever
• Urinary Tract infection
• Momentary haematuria
• Acute urinary incontinence
• Ureter avulsion
• Bleeding
• Sepsis

Despite the risks, a RIRS surgery can be a good choice for people with kidney stones. The chances of countering the risks and side effects can also be ignored or reduced if the surgery is done by an expert urologist at Pristyn care.

• After you arrive home, you'll need to rest. It could be uncomfortable to sit for a few days. Step up your activity level gradually. Avoid engaging in any vigorous activity while your urine has a bloody tint
• After you go home, you can experience pain passing little fragments of stone as well as stinging when you urinate for a few days. A non-steroidal anti-inflammatory medicine (NSAID), such as ibuprofen or diclofenac, may be suggested by your doctor
• Continue to consume enough liquid to maintain the light color of your urine. Consume a lot of water (8–10 liters) each day
• Be sure to keep up a nutritious diet. There should be a lot of foods high in fiber in it. Eat less of the foods that contribute to constipation and excessive effort during bowel movements. For a few days, your doctor might advise taking a mild laxative.
• Reduce your intake of alcohol and caffeinated beverages
• Consult your doctor about the appropriate fluid intake if you suffer from other medical conditions You may be able to reduce your need for future surgery by making dietary and lifestyle changes, depending on the type of kidney stones you have
• A hot bath can be beneficial. You could require a stronger pain reliever if your discomfort is more severe. In order to assist you move stone fragments more easily, your doctor could possibly prescribe medicine
• Antibiotics may be recommended by your doctor to stop and/or treat any infection in your urine. These may need to be taken for a few days or weeks
• To check for small fragments of stone, your doctor can instruct you to strain your urine. Any stones you pass out from your body should be saved so that their types can be determined through analysis. This aids in selecting future treatments
• Follow your surgeon's recommendations on the amount of time off work
• During your initial follow-up session, your doctor might remove a temporary ureteral stent if you had one implanted. There are two techniques for removing a stent. You may notice a thread sticking out of your urethra/penis from some stents since they are attached to strings. This kind of stent is taken out by your doctor by pulling on the string
• Your doctor will perform a surgery called a cystoscopy to remove the second kind of stent, which doesn't have a string.

Retrograde intrarenal surgery or RIRS, is a minimally invasive technique to remove kidney stones that are between 10mm and 14mm in size and are stubborn and unresponsive to procedures like shockwave lithotripsy and ureteroscopy.

The procedure does not require any cuts or incisions and is done using an endoscope for visual aid and holmium laser to break the large stones. This method is the most effective compared to traditional procedures and ensures a quicker recovery, less pain, and minimal blood loss.