Bilateral Retrograde Intrarenal Surgery (RIRS)

Bilateral (B/L) retrograde intrarenal surgery (RIRS) is a laser-driven endoscopic surgical method for kidneys. During RIRS, a flexible ureteroscope is inserted into the urine-collecting portion of the kidney through the urethra, bladder and ureter. The ureteroscope is pushed retrogradely through the urinary tract towards the intrarenal region where the stone is present. B/L RIRS is used to remove  bilateral renal calculi without incising the kidneys.

How is B/L RIRS performed: Before, During and After

B/L RIRS is indicated for patients with kidney stones of 1.5cm in diameter. A fibre optic endoscope and a laser fibre named Holmium are used for eliminating kidney stones in B/L RIRS. Before the surgery, the patient undergoes a body check-up to determine their general health and fitness for the surgery. In some cases, a double J stent is inserted two weeks before the surgery to help with seepage. A urologist, also known as  an endourologist, with adequate expertise performs the procedure.

During the procedure, the ureteroscope is pushed upwards through the urinary tract and placed in the kidney using the live X-ray method called fluoroscopy. In contrast, the patient is under sedation, and the renal stone is crushed, impacted by laser or taken out using forceps. Following B/L RIRS, the patient is discharged from the hospital approximately after 24 hours of the surgery, and proper rest of at least one day is advised before resuming normal daily activities. However, the discharge from the hospital depends on the individual patient’s medical condition. Medicines are prescribed approximately for a week. After a week, a follow-up is scheduled to assess the patient’s condition and ensure that the body is clear of any stones.

Cost of the B/L RIRS

In India, B/L RIRS costs around one lakh fifteen thousand rupees only. Nevertheless, the total cost of the surgery might be more or less than that. It depends on numerous factors such as the hospital chosen, hospital location, rooms selected, insurance coverage, recuperation time, hospital stay length, etc.

Risks and complications of the B/L RIRS

No major complications are typically associated with B/L RIRS. Studies have indicated that RIRS is associated with lower complications than other stone-manipulation modalities like percutaneous nephrolithotomy (PCNL). Rarely observed risks and complications associated with B/L RIRS are:

• Flank Torment 
• Kidney Injuries 
• Sepsis
• Ureter Separation
• Fornix Burst
• Ureteral Pelvicalyceal Scraped Spot
• Urinoma
• Overactive Bladder
• Systemic Inflammatory Response Syndrome
• Transient Haematuria
• Urinary Diseases
• Fever 
• Death in extreme cases