Bilateral Retrograde Intrarenal Surgery (RIRS)

Bilateral (B/L) retrograde intrarenal surgery (RIRS) is a laser-driven endoscopic surgical method for kidneys. During RIRS, a flexible ureteroscope is inserted into the urine-collecting portion of the kidney through the urethra, bladder and ureter. The ureteroscope is pushed retrogradely through the urinary tract towards the intrarenal region where the stone is present. B/L RIRS is used to remove  bilateral renal calculi without incising the kidneys.

How is B/L RIRS performed: Before, During and After

B/L RIRS is indicated for patients with kidney stones of 1.5cm in diameter. A fibre optic endoscope and a laser fibre named Holmium are used for eliminating kidney stones in B/L RIRS. Before the surgery, the patient undergoes a body check-up to determine their general health and fitness for the surgery. In some cases, a double J stent is inserted two weeks before the surgery to help with seepage. A urologist, also known as  an endourologist, with adequate expertise performs the procedure.

During the procedure, the ureteroscope is pushed upwards through the urinary tract and placed in the kidney using the live X-ray method called fluoroscopy. In contrast, the patient is under sedation, and the renal stone is crushed, impacted by laser or taken out using forceps. Following B/L RIRS, the patient is discharged from the hospital approximately after 24 hours of the surgery, and proper rest of at least one day is advised before resuming normal daily activities. However, the discharge from the hospital depends on the individual patient’s medical condition. Medicines are prescribed approximately for a week. After a week, a follow-up is scheduled to assess the patient’s condition and ensure that the body is clear of any stones.

Cost of the B/L RIRS

In India, B/L RIRS costs around one lakh fifteen thousand rupees only. Nevertheless, the total cost of the surgery might be more or less than that. It depends on numerous factors such as the hospital chosen, hospital location, rooms selected, insurance coverage, recuperation time, hospital stay length, etc.

Description Cost

Cost of Surgery in India

Around Rs. 1,15,000

Cost of Surgery in Hyderabad

Rs. 90,000-1,10,000

 

Description Cost

Number of days in the hospital

Approximately one day

Type of surgery

Major

Anaesthesia type

Spinal or general or local anaesthesia

Recovery

Around two days

Duration of the procedure

One to two hours

Surgery

Minimally invasive

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    Risks and complications of the B/L RIRS

    No major complications are typically associated with B/L RIRS. Studies have indicated that RIRS is associated with lower complications than other stone-manipulation modalities like percutaneous nephrolithotomy (PCNL). Rarely observed risks and complications associated with B/L RIRS are:

    • Flank Torment 
    • Kidney Injuries 
    • Sepsis
    • Ureter Separation
    • Fornix Burst
    • Ureteral Pelvicalyceal Scraped Spot
    • Urinoma
    • Overactive Bladder
    • Systemic Inflammatory Response Syndrome
    • Transient Haematuria
    • Urinary Diseases
    • Fever 
    • Death in extreme cases

    Disclaimer: The information provided herein is accurate, updated and complete as per the best practices of the Company. Please note that this information should not be treated as a replacement for physical medical consultation or advice. We do not guarantee the accuracy and the completeness of the information so provided. The absence of any information and/or warning to any drug shall not be considered and assumed as an implied assurance of the Company. We do not take any responsibility for the consequences arising out of the aforementioned information and strongly recommend you for a physical consultation in case of any queries or doubts.

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    Frequently Asked Questions about Bilateral Retrograde Intrarenal Surgery (RIRS)

    Stenting following RIRS is not always necessary, especially for patients without any complications. Inserting a stent is associated with an increase in treatment cost, operation time and risks related to mortality. However, stents are inserted after RIRS to prevent blockage of the ureter with post-operative oedema or blood clots and permit urine drainage.

    Straining to defecate is warned following stenting as it might result in bleeding. Usually, bowel movements on alternate days are appropriate. If there is any difficulty associated with defecation, consult the healthcare professional.

    RIRS is faster than traditional kidney-stone-removal procedures. It usually lasts around one to two hours, whereas Percutaneous Nephrolithotomy(PCNL) lasts for approximately three to four hours. Moreover, its recovery time is also shorter than that of other traditional procedures.

    Compared with PCNL, RIRS is better on the basis of factors such as hospital stay, analgesic use, pain, decrease in haemoglobin and fluoroscopy time. RIRS is a non-invasive method, whereas PCNL is invasive. Thus, recovery is faster in RIRS than in PCNL.

    RIRS is considered the safest modality in kidney-stone manipulation as it has fewer complications when compared with PCNL. In addition, RIRS can be performed in patients with bleeding diathesis, ectopic kidneys or chronic renal failure.

    Generally, following RIRS, high pain is not reported. In particular, compared with other renal stone manipulation modalities, RIRS is associated with no pain, and its recovery time is also minimal. The average pain score of RIRS is 2.38/10 according to the numerical rating scale in a prior study.