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kidney stone management: URS / RIRS

URS is a type of treatment which is done using a small caliber endoscope that is passed through the urethra without making an incision in your body. The stone is pulled out by basket or fragmented by laser. In RIRS, or Retrograde Intrarenal Surgery, a flexible fine endoscope is passed into the kidney through natural opening and then the stones are fragmented under direct vision using laser. Stone clearance rate is very high, complications are minimal & patient is discharged within 24 hrs. Also, it is very expensive & not suited for all types of stones. More than 300 RIRS have been performed at our hospital during the last 8 years.



Fine rigid endoscope is passed through urethra into the ureter; stones are fragmented using laser. Following the procedure stent is placed across the ureter; this helps in healing and pain free passage of stone particles. Placing a stent also helps to avoid complication like infection in the kidney. URS is ideal for stones in lower and mid ureter. Beyond that high up in ureter, URS may be difficult as ureter is tortuous and there may be kinks and bends, thus rigid scope is not easy to move up. Moreover manipulation in upper ureter may push the stone into the kidney, thus making procedure more difficult. In such situations, RIRS or PCNL may be only other alternative. 



Ideal for stone in upper ureter or inside the kidney. A flexible scope is passed up the ureter inside the kidney and stones are fragmented using laser. Fragmented stones are passed out gradually within a few days or weeks. Larger fragments may be retrieved using graspers and zero tip baskets. 

RRS is a good alternative to PCNL which is more invasive and more chance of significant bleeding. But there are few limitation to RIRS like large stone usually >1.5 cm are not amenable or may need multiple sittings. Sometimes stones are in a branch which are difficult to reach. Sometimes narrow urethra doesn’t allow the flexible scope to go through the ureter. In such a situation prior DJ stenting 10-15 days before RIRS is required. 

URS/ RIRS usually takes 30’-60’ to perform. Pre-operative investigations like USG, IVP, Urine culture is mandatory. Detailed pre anaesthesia check-ups are carried out. Patients are admitted on the day of surgery. Usually discharged within 24 hours. Possible complications like mild to moderate bleeding, fever are occasionally encountered and are easily managed. 


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