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RIRS (Retrograde Intrarenal Surgery)

Flexible Ureteroscopic Laser Lithotripsy for Renal Stones

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is RIRS (Retrograde Intrarenal Surgery)?

Retrograde intrarenal surgery (RIRS) uses a flexible digital or fiber-optic ureteroscope passed through the urethra, bladder, and ureter to reach the renal collecting system.

Stone fragmentation: holmium:YAG laser (most common) or thulium fiber laser (newer, smaller fragments, faster ablation).

Stone retrieval: nitinol baskets or fragmentation to dust ("dusting" technique) for spontaneous passage.

Performed under general or spinal anesthesia; outpatient or short-stay procedure.

Indications: renal stones 1-2 cm, lower pole stones with unfavorable anatomy for SWL, ESWL failure, anatomical anomalies (horseshoe kidney, calyceal diverticulum).

Stone-free rates: 75-95% depending on stone size, location, composition, and operator experience.

Compared to PCNL (percutaneous nephrolithotomy): less invasive, lower complication rates, but lower stone-free rate for large stones (over 2 cm).

Symptoms

Renal stone size 1-2 cm (single or multiple).
Lower pole stones with unfavorable infundibulopelvic angle.
Failed shock wave lithotripsy (SWL).
Anatomical anomalies: horseshoe kidney, ectopic kidney, calyceal diverticulum, ureteropelvic junction obstruction.
Bleeding diathesis or anticoagulation (preferred over PCNL).
Obesity (limits SWL effectiveness).
Cystine stones (resistant to SWL fragmentation).
Bilateral renal stones requiring single-stage treatment.

Risk Factors

Active urinary tract infection (must be treated first).
Untreated coagulopathy (relative).
Severe urethral or ureteral stricture preventing scope advancement.
Anatomic abnormalities limiting flexible scope deflection.
Pregnancy (relative; ureteroscopy with regional anesthesia preferred over SWL).
Stones over 2 cm (consider PCNL or staged RIRS).
Renal pelvic infection or sepsis (priority drainage with stent or nephrostomy first).

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Documented renal stone with persistent flank pain or recurrent UTIs.
  • Hematuria attributable to known renal calculi.
  • Failed SWL with residual stone fragments.
  • Recurrent stone formation with anatomical risk factors.
  • Family history of stone disease with first symptomatic episode.
  • Pregnancy with symptomatic kidney stones (multidisciplinary urology referral).

Treatment Methods

01
Pre-procedure: urine culture (treat any infection), CT urogram (stone location, size, density, anatomy), KUB X-ray.
02
Pre-stenting (DJ stent 1-2 weeks prior) for tight ureters or large stones; passive ureteral dilation.
03
Patient positioning: lithotomy under general or spinal anesthesia.
04
Cystoscopic insertion of guidewire and access sheath (12/14 Fr typical).
05
Flexible ureteroscope (8-10 Fr) advanced over guidewire; endoscopic stone visualization.
06
Laser lithotripsy (holmium 30-100 W or thulium fiber laser) with fragmentation or dusting technique.
07
Stone retrieval with nitinol basket; or dusting and spontaneous passage.
08
Post-procedure DJ stent placement (1-2 weeks) for ureteral edema and fragment passage.
09
Postoperative care: alpha-blockers (tamsulosin) for stent symptoms, hydration, NSAIDs for pain.
10
Stent removal at 1-2 weeks under local cystoscopy.
11
Stone-free assessment: KUB, ultrasound, or low-dose CT at 4-6 weeks.
12
Metabolic workup: 24-hour urine, serum chemistry, stone analysis for prevention strategy.

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.