RIRS: a minimally invasive way to treat many kidney stones—when the stone pattern is suitable
RIRS stands for Retrograde Intrarenal Surgery. Practically, it means using a flexible endoscope to reach the kidney through the natural urine passage and treat a stone with laser—without a skin incision. RIRS can be an excellent option for many kidney stone patterns. But it is not 'one size fits all.' The most important determinants are: stone size and burden, stone location inside the kidney, anatomy and access, infection/obstruction risk, and your medical profile.
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When RIRS is recommended (common scenarios)
RIRS is typically considered when: The stone is in the kidney (not just the ureter). The stone size/burden and kidney anatomy suggest good chance of effective clearance. Conservative management is not appropriate or has failed. You want a minimally invasive endoscopic approach and are a suitable candidate. There is recurrent pain, repeated ER visits, or persistent stone presence with symptoms. You have a stone pattern where RIRS offers a good balance of safety and effectiveness. RIRS is often chosen because it avoids a direct puncture into the kidney (as in PCNL) while still allowing active stone treatment.
When RIRS may not be the best option
RIRS may be less suitable when: stone burden is large (clearance may be incomplete or require multiple sessions), stones are complex (e.g., branching patterns), certain locations/anatomy make access difficult and clearance less reliable, there is significant infection with obstruction requiring urgent drainage first, there are constraints where a single definitive clearance approach is preferred. In these situations, mini-PCNL may be considered because it can remove larger stone burdens more efficiently in a single session.
Tests needed before planning RIRS
1) Urine test (routine; culture when indicated)
This is critical. If infection is present, it must be treated appropriately. Stone work should not proceed in an unsafe infection context.
2) Imaging that defines stone burden and location
Ultrasound is useful as a starting point. CT KUB often provides the best detail on size/location and helps procedural planning.
3) Kidney function in selected cases
Especially if: obstruction has been prolonged, there is one kidney, there is known kidney disease.
4) Review of previous stone history
Recurrence history helps plan prevention after treatment.
What happens during RIRS
RIRS is performed through the natural urine passage. In simple terms: A scope is passed through the urethra into the bladder and then into the ureter. A flexible ureteroscope is advanced into the kidney's collecting system. The stone is visualized and fragmented using a laser. Fragments are either removed, or 'dusted' into fine particles that can pass naturally. A stent is commonly placed afterward to support drainage and healing. No skin incision is typically required.
Stent: why it is used and what it feels like
Why a stent is placed
Stents are very common after RIRS. The ureter can swell after instrumentation. Fragments can cause temporary irritation. The stent keeps the drainage pathway open. It reduces risk of painful blockage.
What it can feel like
Common stent symptoms: urgency/frequency, burning sensation, lower abdominal discomfort, flank discomfort during urination, mild blood in urine. These symptoms are common and temporary. Knowing this in advance prevents unnecessary worry.
Recovery timeline
First 24–72 hours
Urinary burning and frequency are common. Mild blood in urine may occur. Discomfort fluctuates, often influenced by stent.
First 1–2 weeks
Many patients return to routine activities within days (job-dependent). Stent removal timing is planned based on case specifics. Symptoms typically improve over time.
After stent removal
Many patients feel noticeably better within 24–48 hours. Mild burning can persist briefly.
Risks and side effects
RIRS is widely performed, but it is still a procedure. Potential risks include: infection (screened and managed with protocols), bleeding (usually mild), ureteric injury (rare, but possible), residual fragments ('dust' or small fragments may remain), need for repeat treatment if stone burden is high or access is challenging, stent discomfort. Seek urgent evaluation if: fever/chills, severe pain with fever, inability to pass urine, heavy bleeding with clots, uncontrolled pain/vomiting.
RIRS vs URSL vs mini-PCNL (how to choose)
URSL
Best aligned with stones in the ureter. Scope reaches ureter; laser fragmentation.
RIRS
Best aligned with many stones in the kidney that are suitable for flexible scope clearance. Minimally invasive; may require stent.
Mini-PCNL
Best aligned with larger or more complex kidney stones where direct access improves clearance efficiency. More definitive for certain burdens.
The best choice is not about trend. It is about stone clearance probability with minimal risk. MyDocsy's senior urologists are trained to offer you the best possible option for you without bias.
FAQs
Talk to a doctor / plan your RIRS
If you're considering RIRS, the most useful inputs are: CT KUB report (stone size, location, number), urine report (and culture if done), your pain pattern and whether fever/chills occurred, kidney function report if one kidney/known kidney disease. We will guide you on: whether RIRS is likely to clear your stone pattern effectively, whether mini-PCNL is a better fit, stent expectations and recovery planning, follow-up and prevention planning after treatment.
