RIRS Surgery

What is RIRS Surgery?

RIRS (Retrograde Intrarenal Surgery) is an advanced endoscopic procedure used for the removal of kidney stones with the help of flexible ureteroscopes, both fiberoptic and digital (chip-on-the-tip), holmium laser, thulium fiber laser access sheaths, tipless baskets, and wires etc., through natural urinary passages.

Unlike conventional surgery, RIRS does not require any incision or puncture or artificial hole on the body. The procedure allows the surgeon to directly reach the kidney, visualize the stone, fragment it using laser energy and remove the stone fragments safely.

Why Do Kidney Stones Need Treatment?

Kidney stones are hard deposits of minerals and salts that form inside the kidneys. While mostly small stones may pass naturally through the urine, larger stones or stones located in certain parts of the kidney or urinary tract may not pass on their own.

These stones can cause:

• Severe pain (renal colic)
• Blood in the urine
• Urinary tract infections
• Blockage of urine flow
• Damage to the kidneys if left untreated

If a kidney stone is too large to pass naturally, causes constant problems, or is likely to damage the kidney, your doctor may recommend surgical removal of the Kidney Stones. Removal of Kidney stones may require URS, PCNL, RIRS, or sometimes ESWL.

Why is RIRS Becoming Increasingly Popular?

RIRS is widely regarded as one of the least invasive methods for kidney stone removal.

Benefits of RIRS surgery includes:

• No incision
• No hole in the kidney
• No visible scar
• Minimal blood loss
• Less postoperative pain
• Faster recovery
• Short hospital stay
• Day-care treatment in many patients
• Early return to work
• High stone clearance rates
• Suitable for complex kidney anatomy

Because of these advantages, RIRS has become one of the preferred treatment options for kidney stone removal worldwide.

RIRS – A No Hole, No Cut, Safest Day-Care Procedure

One of the biggest advantages of RIRS surgery is that it is performed entirely through the natural urinary passage.

As there is:

• No incision
• No puncture
• No surgical wound

Patients usually experience less discomfort and recover much faster compared to many traditional kidney stone procedures. Many patients are able to return to routine activities within a short period after surgery.

When is RIRS Recommended?

RIRS is a safe and effective treatment for many patients with kidney stones. Urologist may recommend RIRS based on the size, location and type of stone, as well as your overall health.

RIRS may be recommended for:

• Kidney stones that are up to about 3 cm in size and cannot be treated with non-surgical methods.
• Stones located in areas of the kidney that are difficult to reach with other treatment options.
• Selected larger kidney stones. In some cases, more than one treatment session may be required.

Note: RIRS is not the best treatment for every kidney stone. Very large stones, complex stone burdens may be better treated with other procedures, such as PCNL. Your urologist will recommend the most appropriate treatment after a detailed evaluation.

How is RIRS Surgery Performed?

RIRS is a minimally invasive procedure for kidney stone removal that uses advanced flexible ureteroscopes and Holmium laser/ TFL. Performed through the natural urinary passage without any incision, it offers effective stone treatment with faster recovery and minimal discomfort.

The RIRS procedure consists of the following steps:

• A flexible ureteroscope is passed through the natural urinary passage, with or without an access sheath placed in the ureter.
• The scope is then advanced into the collecting part of the kidney, known as the Pelvicalyceal System.
• The kidney stone is directly visualized through the ureteroscope.
• The stone is fragmented using a Holmium laser fibre/ TFL f
• The stone fragments so formed are basketed and removed using specialized stone retrieval baskets or with suction using FANS or DISS.
• Alternatively, the stone may be dusted into fine particles using the Holmium laser or Thulium Fiber Laser & fragments are left behind for spontaneous passage later.
• After the stone has been dusted or removed, a Double J (DJ) stent is usually placed between the kidney and the ureter.
• The DJ stent is generally removed after a few
• No Stent RIRS is also possible depending upon the size, location and several other factors.

Since the procedure is performed through natural passages, there is no surgical cut or hole made in the kidney.

Who Can Benefit from RIRS Surgery?

RIRS surgery is a minimally invasive procedure that can be used to treat a wide range of kidney stone cases. It is particularly beneficial for certain patients and clinical situations where a no-cut, no-hole approach offers significant advantages. Following a detailed evaluation, Urologist can determine whether RIRS is the most appropriate treatment option for you.

RIRS may be particularly beneficial for:

Patients with:

• Recurrent kidney stones
• Stones located in difficult parts of the kidney
• Bilateral kidney stones
• Residual stones after previous treatment

Special patient groups

• Obese patients: RIRS is considered a safe and effective option for obese patients because no skin puncture is required.
• Patients on blood thinners: RIRS can often be performed safely in selected patients taking anticoagulant medications, depending on individual medical evaluation.
• Patients with bleeding disorders: Patients with bleeding tendencies may benefit from RIRS because of its minimally invasive nature.

Horseshoe kidneys and anomalous kidneys

Because RIRS is performed using a flexible ureteroscope through the natural urinary passage, it can be an effective option for treating kidney stones in patients with horseshoe kidneys and other anatomical variations of the urinary tract.

Can Large Kidney Stones Be Treated by RIRS?

Yes, large kidney stones can be very well treated by RIRS sometimes in stages with advancements in:

• Digital flexible ureteroscopes
• High-powered Holmium laser/ TFL laser
• Improved stone retrieval systems

RIRS can now be used for many large kidney stones.

At R P Stone Clinic, even selected staghorn kidney stones are treated using RIRS surgery.

The suitability of RIRS depends on factors such as:

• Stone size
• Stone location
• Stone burden
• Kidney anatomy
• Overall patient condition

A detailed evaluation by Dr. Pawan K. Gupta helps determine the most appropriate treatment plan.

Our Journey Through RIRS Surgery

The journey of RIRS at R P Stone Clinic started when flexible ureteroscopes did not have deflection mechanisms.

In 1991, Dr. Pawan K. Gupta first acquired a flexible ureteroscope imported from Germany. At that time, the technology was primitive compared to modern instruments and had limited functionality.

The real breakthrough came in 1998 when Dr. Gupta actively started using flexible ureteroscopy for kidney stone treatment at R P Stone Clinic, Panipat.

The same year, he organized a workshop on rigid and flexible ureteroscopy under the aegis of the North Zone Chapter of the Urological Society of India.

The workshop featured internationally renowned experts including:

• Andreas Gross (Germany)
• David Albala (USA)

For the first time in India, the use of a flexible ureteroscope for kidney stone treatment was demonstrated during this workshop.

International Workshops and Training Programs

Dr. Pawan Kumar Gupta organized a workshop at RP Stone Clinic Pvt. Ltd. on 12th and 13th December, 1998 under the aegis of North Zone chapter of Urological Society of India where flexible ureteroscopy and holmium laser lithotripsy, commonly called RIRS today, was introduced.

In 2011, Urological Society of India organized a 2 day workshop on RIRS at RP Stone Clinic, Panipat, with Dr. Pawan K. Gupta as the Organizing Secretary.

Highlights of the workshop included:

• Participation of approximately 200 urologists.
• Attendance by delegates from India and abroad.
• Eight live RIRS surgery cases were demonstrated.
• Four procedures performed by Dr. Pawan K. Gupta.
• Four procedures performed by Dr. Andreas Gross.

Another major workshop followed in 2012.

Since then, regular RIRS training programs have been conducted at the clinic, helping train urologists in advanced endourological techniques under Cook Vista organized by Cook Medical. With the result, today even staghorn stones are being removed by RIRS surgery at our kidney stone hospital.

More Than 27 Years of Experience with RIRS Surgery

Since 1998, Dr. Pawan K. Gupta has been regularly performing RIRS surgery at R P Stone Clinic.

Experience highlights

• More than 45 years of experience in kidney stone treatment.
• Pioneer of RIRS surgery in India.
• Performing RIRS procedures since 1998.
• Thousands of successful RIRS procedures.
• Organizer of multiple RIRS workshops.
• Contributor to research and innovation in endourology.

Advanced Technology Available at R P Stone Clinic

The clinic is equipped with a complete range of endourological equipment for RIRS surgeries, including:

• Single use Flexible Ureteroscope Flex XC1 from Karl Storz, Germany.
• Fiberoptic Flexible Ureteroscopes
• Semirigid Ureterorenoscopes
• Holmium Laser/ TFL Laser
• Ureteral Access Sheaths
• Stone Retrieval Baskets
• Advanced Endourological Accessories

Digital (Chip on the Tip) Flexible Ureteroscopes at R P Stone Clinic, Panipat

Digital (Chip on the Tip) and Fiberoptic Flexbile Ureteroscopes available at R P Stone Clinic, Panipat

Numerous Semirigid Ureterorenoscopes available at R P Stone Clinic, Panipat

Holmium Lasers at R P Stone Clinic, Panipat

Thulim Fiber Laser

Single use Digital Flexible Ureterscope Flex XC1, Karl Storz, Germany.

Why Choose Dr. Pawan K. Gupta for RIRS Surgery in Panipat?

Patients Choose R P Stone Clinic Because Of:

• Pioneer experience in RIRS surgery.
• Advanced digital flexible ureteroscopes.
• Modern Holmium laser & TFL laser
• Expertise in complex kidney stone treatment.
• Treatment of large and staghorn kidney stones.
• Thousands of successful procedures.
• Personalized patient care.
• Easy accessibility from across North India.

Consult Dr. Pawan K. Gupta for RIRS Surgery in Panipat

If you are looking for advanced RIRS surgery, laser kidney stone treatment, kidney stone removal without surgery or expert care for complex kidney stones, consult Dr. Pawan K. Gupta at R P Stone Clinic, Panipat, Haryana.

With extensive experience, advanced procedure and a long-standing commitment to innovation in kidney stone treatment, the clinic continues to provide world-class care to patients from across India and abroad.

Seeking for the most advanced kidney stone treatment in Panipat? Visit R P Stone Clinic, Panipat, Haryana, a pioneer centre for RIRS surgery in India.