RIRS Surgery for Kidney Stones

Retrograde Intrarenal Surgery, commonly called RIRS surgery, is a minimally invasive endoscopic procedure used to treat selected kidney stones. A flexible ureteroscope is carefully passed through the urinary tract to reach the kidney, where laser energy might be used to break the stone into smaller fragments. The approach usually does not require an external skin incision, though whether RIRS surgery for kidney stones is right for a particular stone depends on multiple factors.

Book a consultation with a NU Hospitals’ urologist for RIRS in Bengaluru to find out whether RIRS or another treatment is appropriate for your condition.

What Is RIRS Surgery?

RIRS full form is Retrograde Intrarenal Surgery. Here, retrograde means the surgeon works backwards along the urinary tract; in through the urethra, up through the bladder, then the ureter, until they reach the kidney. Intrarenal means inside the kidney, where the stones are found and disintegrated.

Surgeons reach the kidney using a flexible ureteroscope, a thin scope that can be bent as it moves up through the urinary tract. Once it's in position, the surgeon can see the stone directly and break it apart with a laser. This step is called laser lithotripsy. The smallest fragments are usually left to pass on their own in the RIRS laser procedure. Anything larger is taken out with a small basket passed through the same scope.

Open surgery needs a bigger incision to reach the kidney directly. RIRS doesn't, since the scope travels through a passage the body already has.

Note: RIRS surgery for kidney stones, ureteroscopy and laser lithotripsy are related but not identical. Ureteroscopy refers to any procedure done in the ureter using a semirigid scope. Flexible ureteroscopy scope is long enough to reach the kidney and bends to visualise all parts of the kidney. RIRS refers to the full procedure for treating a stone in the kidney via this route. Laser lithotripsy is the fragmentation technique used once the stone is in view.

When May RIRS Be Recommended?

A urologist may consider RIRS kidney stone surgery in a number of situations, including:

●   A stone that's unlikely to pass on its own, or one causing ongoing symptoms

●   A stone within the kidney's collecting system, especially where other approaches have drawbacks

●   A stone that hasn't responded to shockwave (ESWL) treatment

●   Residual fragments left over from an earlier PCNL procedure

●   Cases where the patient would prefer to avoid a skin puncture

●   Multiple stones, or stones in difficult to reach parts of the kidney, depending on imaging studies

A urologist considers stone size, number, location and CT Hounsfield units (HU) which measures stone hardness, alongside the patient's anatomy, any blockage or infection, kidney function, prior treatment history, and general health. Two people with similarly sized stones can receive different recommendations because of the above factors.

Bringing previous scans and reports to your consultation helps the urologist assess this accurately from the start.

Who May Need a Different Treatment First?

RIRS isn't always the first option. A urologist may recommend a different approach if:

●   There's an untreated urinary infection, which usually needs to be treated before any stone procedure

●   The patient needs urgent kidney drainage due to renal dysfunction

●   The stone burden is very large, or it's a staghorn stone that fills much of the collecting system

●   The kidney's anatomy makes it hard for a scope to reach the stone

●   The patient has a health condition that affects how safely anaesthesia can be given

●   The patient is pregnant, which changes what treatments are appropriate

How Is RIRS Surgery Performed?

Before the Procedure

The urologist first asks about symptoms, then reviews the patient's medical history. A CT scan or ultrasound follows. This tells the urologist the stone's size and exact location. Blood and urine tests are also done. If there's an infection, these tests will pick it up, and they also show your renal function. Any infection found at this stage is treated before the RIRS surgery procedure.

The urologist also reviews current medications and arranges anaesthesia assessment. Patients receive instructions on fasting and hospital admission ahead of the procedure. Shortly before surgery, the team meets with the patient to explain what to expect, which forms part of the consent process.

During the Procedure

Here are the steps in RIRS surgery:

●   Anaesthesia is administered. The type used and how the patient is prepared is decided by the anaesthesia team.

●   The urethra and bladder is first assessed  by cystoscopy. Then semi-rigid ureteroscopy is performed to assess the ureter. 

●    An access sheath is placed under Fluoroscopy guidance up to the upper ureter and flexible ureteroscope is passed to reach the kidney. The Urologist navigates the collecting system. 

●   The surgeon locates the stone and assesses its accessibility.

●   The stone is fragmented using laser energy, either into dust or larger pieces.

●   Small fragments shall pass out naturally down the ureter. Some larger pieces are retrieved with a small basket .

●   A stent may be placed to help urine drain while the ureter heals from any swelling.

After the Procedure

Patients are monitored in the recovery room for any pain, nausea and to monitor urine output. Discharge is usually after overnight stay.. Before discharge, the patient is given medication instructions. If the patient has a stent, the team explains what to expect. A follow-up appointment is also scheduled. Sometimes further imaging is needed too, to check if the stone is cleared after the laser RIRS surgery.

Benefits of RIRS

Patients who are advised RIRS can benefit from this advanced procedure for kidney stones in the following ways-

●   Usually performed without an external skin incision

●   Allows the surgeon to see stones directly inside the kidney

●   Laser fragmentation happens under direct visual guidance

●   May involve less bleeding than procedures requiring a tract through the skin

●   Shorter hospital stay for many patients

●   Relatively faster return to routine activities than open surgery

●   Can reach stones in different parts of the kidney's collecting system

●   An option for patients unsuitable for shockwave treatment

●   More than one stone can sometimes be treated in a single session

●   Generally no skin scarring compared to incision-based surgery

The extent of these benefits depends on the size, number and location of the stones, the patient's anatomy and health, and whether more than one session is needed.

RIRS Versus Other Kidney Stone Treatments

 

RIRS versus ESWL

ESWL breaks up the stone with shockwaves fired in from outside the body. RIRS is different because the scope actually reaches the stone and breaks the stone after direct contact. Anaesthesia needs, stone clearance rates and the likelihood of a repeat session vary by location and density for both procedures. A dense stone that doesn't respond well to shockwaves may suit RIRS better. Visit NU Hospitals to see our detailed cost and treatment comparison.

RIRS versus URSL

URSL involves treating a stone within the ureter itself, while RIRS specifically means reaching and treating a stone inside the kidney with a flexible scope.

RIRS versus PCNL

PCNL accesses the kidney through a small puncture in the skin of the back and creates a tract to enter the kidney while RIRS it is through the urinary tract. PCNL is commonly considered for larger or more complex stones that would be difficult to clear with RIRS treatment alone, though staged RIRS is sometimes used instead of switching approaches.

The urologist reviews the images and examines the patient before recommending a procedure.

Is RIRS Painful?

Patients are under anaesthesia during RIRS, so there's no pain during the procedure. Some pain after RIRS is expected. Burning during urination is common, along with a small amount of blood in the urine for a day or two. Patients with a stent often notice flank discomfort, urgency or burning urination. Take medication as prescribed and contact the medical team if any symptoms feel severe or continue to worsen.

What Is the Recovery Time After RIRS?

Hospital stay

Most patients are discharged the next day. But may require longer stay if there is fever or pain post op.

First few days

Mild soreness is common in the first few days, along with burning during urination and more frequent trips to the bathroom. Small traces of blood in the urine can also show up. Patients with a stent may notice these symptoms lasting a bit longer. For effective care after RIRS surgery, drink fluids as your doctor recommends, and take your medication on schedule.

Return to work and routine activities

There's no single timeline for recovery after RIRS surgery. It depends on the type of work, how you're feeling, whether a stent is still in place, and how complex the procedure was. Some return to a desk job within a couple of days, but some might need longer.

Exercise, driving and sexual activity

Follow the specific discharge instructions from your team.

Follow-up

This includes stent removal if one was placed, review of stone analysis if needed, and possibly further imaging. For patients with recurrent stones, the urologist may suggest a metabolic evaluation and discuss steps to reduce future risk.

Ureteral Stent After RIRS

A ureteral stent is a thin, flexible tube placed temporarily in the ureter to keep it open so urine can drain while it heals from procedure-related swelling. Not every patient needs one. It depends on the surgery and the individual circumstances.

Common stent-related symptoms include frequent urination, urgency, burning, flank discomfort, and occasionally some blood in the urine. Stent pain after RIRS usually improves once the stent is removed. Removal timing depends on the treating urologist's plan. If stent symptoms become severe, or fever, heavy bleeding or an inability to urinate develops, contact the hospital immediately.

Do not miss the advised stent-removal or follow-up appointment. Leaving a stent in longer than recommended can lead to complications.

Possible Side Effects and Complications

Expected short-term symptoms

Symptoms can include mild urinary burning, temporary blood in the urine, mild pain, increased frequency or urgency, stent-related discomfort, and tiredness from anaesthesia. Most of this settles within a few days. Contact the team if anything is still bothering you after that, or if it gets worse instead of better.

Potential RIRS complications

Potential complications of RIRS include urinary infection after RIRS, bleeding, ureteral injury, swelling that can lead to obstruction, difficulty passing urine, residual stone fragments, the need for a stent or a second procedure, ureteral narrowing over time, and anaesthesia-related complications.

Most patients don't experience serious RIRS surgery side effects, but being aware of what's possible helps recognise when something needs attention.

When to contact the hospital urgently

Contact the treating team promptly or seek urgent medical attention if you experience:

●   Fever or chills

●   Severe or worsening pain

●   Inability to pass urine

●   Heavy or persistent bleeding

●   Persistent vomiting

●   Increasing weakness or confusion

●   Any symptom that is rapidly worsening

●   Any warning sign specifically listed in your discharge instructions

Fever after RIRS can signal infection and should never be treated as routine. If it develops, contact your team promptly.

Can RIRS Remove the Entire Kidney Stone in One Session?

The goal is to treat as much of the relevant stone burden as can be safely managed. For many patients this happens in one session; for others, particularly with larger, multiple or more complex stones, treatment may need to be staged. Very small fragments are sometimes left to pass naturally rather than retrieved, since removing every last particle isn't always necessary. Follow-up imaging is done to check how much stone material remains.

RIRS Surgery Cost

RIRS surgery cost depends on the number and complexity of stones, whether one or more sessions are needed, preoperative tests, anaesthesia, laser and disposable equipment, stent use, hospital stay, additional procedures, insurance authorisation, and follow-up care. These are the main factors affecting the RIRS cost, and they're also why the RIRS surgery cost in India varies so much between cases.

For a detailed breakdown, see our Kidney Stone Treatment Guide to Costs: Laser versus Shockwave in India.

Contact the hospital for an estimate for your RIRS surgery in Bengaluru based on your recommended treatment plan.

Preparing for RIRS Surgery

●   Share a complete list of your medicines, supplements, and any blood thinners with the clinical team, and let them know about any allergies, too.

●   Report fever or urinary symptoms before surgery.

●   Complete the tests your doctor advises and follow the fasting instructions.

●   You'll also need someone to help you get home and manage the first day or two after discharge.

●   Bring previous imaging and medical records.

●  If a medication needs to be paused before surgery, follow only the hospital's specific instructions.

Care After RIRS and Kidney Stone Prevention

●   Follow your discharge instructions, take prescribed medication as directed, and attend follow-up and stent removal appointments.

●   Complete any recommended imaging.

●   If stone analysis is available, ask about it, since knowing the stone type can guide prevention.

●   For recurrent stones, a metabolic evaluation may be suggested.

●   Hydration and diet after RIRS surgery help reduce future stone risk, though the right approach varies from person to person.

●   Check with your doctor before making significant dietary changes.

For more, see our guide on Kidney Stone Prevention: Essential Diet & Lifestyle Changes.

RIRS Treatment at NU Hospitals in Bengaluru

NU Hospitals' urology teams in Bengaluru treat kidney stones. A urologist decides between RIRS treatment in Bengaluru and other approaches based on the stone's size, location and complexity. Branches offer flexible ureteroscopy, along with the imaging and laser equipment needed to perform it. Anaesthesia support and follow-up care, including stent removal, are part of the same process.

Find the nearest NU Hospitals branch and book your consultation.

Why Choose NU Hospitals for RIRS?

The urology team assesses the stone's size, location, and other details using imaging and lab work. From there, they decide whether the RIRS procedure or another treatment fits. Branches are equipped for flexible ureteroscopy and laser treatment, and anaesthesia and inpatient care are available for the procedure itself. After surgery, the team follows up on recovery and stent removal. For patients at risk of recurrent stones, they also advise on reducing that risk going forward. In cases involving broader kidney health, urology works alongside nephrology.

To find out more about an RIRS specialist in Bengaluru, reach out through the hospital's appointment line or website. A second opinion is available for patients who'd like one.

Book an RIRS Consultation in Bengaluru

The treatment recommended for a kidney stone depends on its size, location, number, and complexity, as well as the patient's symptoms, anatomy, and overall health. An NU Hospitals urologist in Bengaluru can review your scans and explain whether RIRS surgery in Bangalore or another treatment may be right for you. Book an appointment to consult a urologist today.

Frequently Asked Questions

Q. What is the full form of RIRS?

Retrograde Intrarenal Surgery treats a stone inside the kidney by reaching it through the natural urinary passage rather than through an external cut.

Q. Is RIRS the same as ureteroscopy?

No. Ureteroscopy involves using a semirigid scope in the ureter. Flexible ureteroscopy involves using scope that can bend and reach inside the kidney.

Q. Is RIRS the same as laser lithotripsy?

No. Laser lithotripsy is the technique used to fragment a stone anywhere in the urinary tract  using laser fiber. 

Q. Does RIRS involve an incision?

No. RIRS is performed through the natural urinary passage, so an external skin incision is not required.

Q. Is RIRS painful?

The procedure itself is done under anaesthesia. Some discomfort is common afterwards. Burning during urination and stent-related symptoms are usually manageable with prescribed medication.

Q. Is RIRS performed under general anaesthesia?

RIRS is generally performed under general anaesthesia. However, specific types of anesthesia are determined by anaesthesia teams based on the case.

Q. How long does RIRS surgery take?

Duration depends on the stones burden being treated, and whether the stone is easy or hard to break.

Q. How long is the hospital stay after RIRS?

Most patients go home the next day. 

Q. What is the recovery time after RIRS?

Most patients feel noticeably better within a few days. Everyone's timeline is a little different, so go by the guidance you're given at discharge rather than a general estimate.

Q. Can I return to work after RIRS?

Some patients are back at work within a couple of days. Others need longer, especially with physically demanding jobs, a stent still in place, or if recovery is taking a bit more time. Ask your doctor for a timeline once they've checked how you're recovering.

Q. Is a stent always required after RIRS?

No. Some patients need one; some don't. Your surgeon decides based on what they find during the procedure.

Q. How long does a stent remain after RIRS?

Your surgeon makes a decision based on your case and lets you know at the time of discharge but it should not exceed 3 months.

Q. Is blood in the urine expected after RIRS?

A small amount for a short period is common. Heavy, persistent or increasing bleeding should be reported to your team.

Q. What causes fever after RIRS?

Fever can be a sign of infection and should be reported to your doctor promptly.

Q. What are the possible side effects of RIRS?

Mild burning, some blood in the urine, general discomfort and stent-related symptoms are common in the short term. Infection, bleeding and the need for a repeat procedure are less common but possible. If you develop a fever or can't urinate, contact your team right away.

Q. Can RIRS treat multiple kidney stones?

Yes, sometimes. It comes down to how many stones there are and where they are located. The surgeon will also factor in what can be safely handled in one sitting.

Q. What size kidney stone can be treated with RIRS?

Usually 1 to 1.5 cm size stones. Suitability depends on size, number, location, density, and anatomy, which is why imaging review by a urologist is needed.

Q. Can RIRS treat a large kidney stone?

Sometimes, yes. For bigger or more complex stones, PCNL or a staged RIRS approach often works better.

Q. Can the stone return after RIRS?

RIRS clears the stones that are present there now. It doesn't stop new stones from forming, so recurrence is still possible in future. You need to follow the prevention plan as per the doctor’s advice to reduce the risk of recurrence.

Q. Will I need another procedure after RIRS?

Sometimes yes. Staged treatment or a further procedure may be needed for larger or more complex stone burdens.

Q. Is RIRS better than ESWL?

Neither treatment is better in every case. A dense or awkwardly positioned stone may respond better to RIRS. A smaller, more straightforward stone may be well suited to ESWL. Your urologist will review your case and advise which is appropriate.

Q. How is RIRS different from PCNL?

RIRS works through the natural urinary passage; PCNL accesses the kidney through a small tract in the back. PCNL is generally considered for larger or more complex stone burdens.

Q. Is RIRS surgery available at NU Hospitals in Bengaluru?

Yes. 

Q. Is RIRS covered by health insurance?

Every policy is different. Call the hospital's insurance desk, and they'll help you figure out what your insurer will cover.

Q. How much does RIRS surgery cost?

There's no single cost here. The stone count, the complexity of the procedure, anaesthesia, hospital stay, and any extra care all factor in. Our cost guide breaks this down in detail.