Which Kidney Stone Treatment is Better? Expert Guidance by Dr. Pawan K. Gupta
Kidney stone treatment has evolved tremendously over the last few decades. Treatments that once required large incisions and prolonged hospitalization have now been replaced by highly advanced minimally invasive procedures. Among the most commonly performed surgeries for kidney stones today are RIRS (Retrograde Intrarenal Surgery) and PCNL (Percutaneous Nephrolithotomy).
Experience: 45+
RIRS (Retrograde Intrarenal Surgery) is a minimally invasive procedure used to treat kidney stones. In this method, doctors reach the kidney through the natural urinary passage, so no cut or hole is made on the body. A thin, flexible ureteroscope is passed into the kidney through normal urinary passage to locate the stones. The stones are then broken into small fragments using a holmium or thulium fiber laser, these fragments are either retrieved and removed from the body with baskets or sucked out or sometimes left behind for spontaneous passage later.
PCNL (Percutaneous Nephrolithotomy) is a procedure used to remove large kidney stones that cannot be treated effectively with other methods. During the surgery, a small opening is made on the back to reach the kidney and remove the stones. A nephroscope is inserted through this tract and stones are fragmented and removed.
Both RIRS (Retrograde Intrarenal Surgery) and PCNL (Percutaneous Nephrolithotomy) are established procedures for kidney stone removal. However, they differ significantly in terms of surgical approach, safety, recovery, bleeding risk and patient suitability.
| Parameter | RIRS | PCNL |
|---|---|---|
| Full form | Retrograde Intrarenal Surgery | Percutaneous Nephrolithotomy |
| Surgical approach | RIRS surgery is performed through the natural urinary passage using a flexible ureteroscope, i.e., no artificial hole is created. | PCNL surgery is performed by creating an artificial hole on the back (lumbar region) and kidney of the patient. |
| Artificial hole in the body | No artificial hole is created. | An artificial hole is created through the back and kidney. |
| Skin incision | No incision required. | Small incision required. |
| Bleeding during surgery | Since RIRS surgery is performed through the normal urinary tract, there is usually no bleeding or minimal bleeding. | In PCNL surgery, a hole is made in the body and kidney of the patient and it bleeds. |
| Safety profile | RIRS surgery is considered one of the safest procedures for kidney stone removal. | Though PCNL surgery is considered safe and effective, it is generally associated with a higher risk profile compared to RIRS. |
| Complications | Usually fewer complications. | Higher complication rate compared to RIRS. |
| Patients with bleeding disorders (bleeding diathesis) | Can often be safely performed. | Usually not preferred due to increased bleeding risk. |
| Patients on anti-coagulants (blood thinners) | RIRS surgery for kidney stones can safely be performed in these patients. | PCNL for kidney stone removal is not considered safe in these patients. |
| Patients with chronic renal failure | RIRS surgery is often considered a safer option for these patients. | PCNL for kidney stones in these patients is not as safe as RIRS. |
| Ectopic kidneys (anomalous kidneys) | RIRS surgery usually does not require any additional procedure for removing kidney stones in ectopic kidneys (anomalous kidneys). | PCNL surgery is complicated procedure for removing kidney stones in ectopic kidneys (anomalous kidneys). |
| Postoperative recovery | After RIRS surgery for kidney stones, recovery is generally faster, allowing patients to go back to work early. | PCNL patients usually take longer to recover and get back to work. |
| Return to work | After RIRS surgery, an early return to work is common. | After PCNL, return to work is generally delayed compared to RIRS. |
| Hospital stay | Hospitalization is short in patients who undergo RIRS for the removal of kidney stones. | Hospitalization is a little longer in patients undergoing PCNL for the removal of kidney stones. |
| Visualization during surgery | After the availability of Digital (Chip-on-the-Tip) Flexible Ureteroscopes in the last one decade, the vision during operation in RIRS is extremely good. | During PCNL or mini PCNL, because of the concomitant bleeding that usually occurs in these procedures, the vision may not be that good. However vision is good for conducting surgery. |
| Stone size suitability | At present, RIRS surgery is safe and can be easily performed for kidney stones up to 2 – 3 cm in size. | PCNL can be easily performed even for bigger kidney stones. |
| Treatment of large stones | At our hospital, R P Stone Clinic, RIRS is routinely performed even for larger kidney stones, including staghorn stones. | At our hospital, PCNL is infrequently performed surgery |
| Multiple kidney stones | For multiple small kidney stones, RIRS is a preferred method for kidney stone removal, as the flexible scope can easily examine and locate stones in different calyces without any additional procedure. | For multiple kidney stones, PCNL may not be the preferred operative procedure as surgeons may need to perform multiple punctures in the kidney. |
| Need for multiple kidney punctures | Multiple kidney punctures are not required in RIRS. | During PCNL surgery multiple kidney punctures may be required in selected cases with multiple stones. |
| Cosmetic results | Post-treatment cosmetic results are good after RIRS, as there is no visible scar. | After PCNL surgery a small scar may remain at the puncture site. |
| Patient comfort |
Patient comfort during and after RIRS is generally higher due to less pain and faster recovery. |
Patient comfort during and after PCNL is generally lower because of greater postoperative discomfort and a longer recovery period – when compared to RIRS. |
| Technology required | For RIRS, we need expensive equipment, which includes Digital Flexible Ureteroscopes (Laser TFL), and expensive single-use disposables, which include tip-less baskets and access sheaths. Because of the requirement of the above said equipment, the cost of RIRS is much more. | No expensive equipment is a necessity for this procedure. However, one may use Holmium/ TFL Laser for intracorporeal lithotripsy. |
| Procedure cost | Procedure cost for RIRS is usually higher because of advanced technology and disposable instruments. | Procedure cost for PCNL is generally lower compared to RIRS. |
| Current practice at R P Stone Clinic | RIRS is the preferred treatment for most kidney stone patients who are suitable for it. | PCNL is performed only in selected cases where it offers a clear advantage. |
There is no single procedure that is ideal for every patient. RIRS and PCNL each have specific advantages depending on the clinical situation.
RIRS has become increasingly popular because it allows stone treatment without any incision or hole in the kidney. The procedure is associated with less bleeding, less postoperative discomfort, a shorter hospital stay and faster recovery. It is particularly beneficial for patients, having bleeding disorders, taking blood-thinning medications or have chronic kidney disease.
At R P Stone Clinic, Dr. Pawan K. Gupta carefully evaluates every patient using imaging studies and clinical assessment before recommending the most appropriate treatment. The objective is always to achieve maximum stone clearance with the highest level of safety and patient comfort.
If you are looking for the most advanced kidney stone treatment, consult Dr. Pawan K. Gupta, one of India’s pioneers in RIRS surgery, at R P Stone Clinic in Panipat, Haryana.
Dr. Pawan K. Gupta has been performing advanced kidney stone procedures for more than 45 years and has successfully treated thousands of patients with both simple and complex kidney stones. As a pioneer of RIRS in India with over 27 years of experience in this field, he has played a significant role in popularizing this advanced technique for kidney stone removal across the country.
Is RIRS a safe procedure?
Yes. RIRS (Retrograde Intrarenal Surgery) is a safe and minimally invasive treatment for kidney stones. Because the procedure is performed through the natural urinary passage, no skin incision or artificial hole & tract into the kidney is required. This generally results in less bleeding, reduced postoperative pain, a lower risk of complications and a faster recovery. When performed by an experienced urologist, RIRS has a high success rate and is considered one of the safest modern surgical options for the treatment of kidney stones.
What are the advantages of RIRS over traditional kidney stone surgery?
RIRS offers several advantages over traditional kidney stone surgeries. The procedure is performed through the natural urinary tract, eliminating the need for skin incisions or an artificial opening into the kidney. As a result, patients usually experience less pain, minimal blood loss, a shorter hospital stay, faster recovery and an earlier return to normal activities. RIRS is also particularly beneficial for patients who are at a higher risk of bleeding or those who may not be suitable candidates for more invasive procedures such as PCNL.
Is R P Stone Clinic empanelled with health insurance companies for cashless RIRS surgery in Panipat?
Yes, R P Stone Clinic has empanelment with several reputed insurance providers and TPAs, including
Patients are advised to contact the clinic in advance to verify insurance coverage details before admission and cashless facility eligibility.
Where is R P Stone Clinic located?
R P Stone Clinic is conveniently located at SCF 30-31, Sector 11, Near Angel Prime Mall, HUDA Colony, Panipat, Haryana – 132103, India. The clinic is situated in a well-connected area of Panipat, making it easily accessible for patients from the city as well as nearby towns and districts.
Over the years, we have successfully treated kidney stone patients from Aligarh, Ambala, Amritsar, Bathinda, Bhiwani, Chandigarh, Dehradun, Fatehabad, Gannaur, Ghaziabad, Gohana, Gurgaon, Haridwar, Hisar, Hoshiarpur, Jabalpur, Jagadhari, Jammu & Kashmir, Jind, Kaithal, Kapurthala, Karnal, Kurukshetra, Ludhiana, Mohali, Mussoorie, New Delhi, Noida, Panipat, Pathankot, Patiala, Rohtak, Rudrapur, Safidon, Saharanpur, Samalkha, Shamli, Sonipat, Yamunanagar and many other locations across Haryana and India.
Patients can contact us through our website or by phone for more information or to schedule an appointment.
What is the experience of RIRS kidney stone surgeon Dr. Pawan K. Gupta?
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