What Is Flexible Ureteroscopy (RIRS)?
(RIRS) uses a small, flexible camera called a ureteroscope to
access the urinary tract.
The instrument is introduced through
the urethra and bladder and then advanced through the ureter toward the kidney.
Because no external surgical incision is usually required, the procedure is
considered minimally invasive.
The flexible tip of the instrument
allows the surgeon to access different areas of the kidney and treat stones
that may be difficult to reach with other techniques.
When Is It Recommended?
It may be recommended for patients
with kidney or ureteral stones when ureteroscopic treatment is considered
appropriate.
It may be particularly useful for:
- Small or medium-sized kidney stones.
- Stones located in difficult areas of the kidney.
- Upper ureteral stones.
- Stones that are not suitable for shock-wave treatment.
- Residual stones after previous treatment.
- Patients who require a minimally invasive approach.
The most suitable treatment is
selected after reviewing imaging studies and evaluating the patient's
individual condition.
Symptoms of Kidney and Ureteral Stones
Stones can cause symptoms when they
obstruct urine flow or irritate the urinary tract.
Possible symptoms include:
- Pain in the side or lower back.
- Pain extending toward the groin.
- Blood in the urine.
- Burning during urination.
- Frequent urination.
- Nausea or vomiting.
- Difficulty passing urine.
- Fever or chills if an infection is present.
Some stones may not cause symptoms
and can be discovered during imaging performed for another reason.
How Is RIRS Performed?
RIRS is generally performed under
general anesthesia.
The procedure usually follows these
steps:
1.
The
patient receives anesthesia.
2.
A
flexible ureteroscope is introduced through the urethra and bladder.
3.
The
instrument is carefully advanced through the ureter toward the kidney.
4.
The
stone is identified using the camera.
5.
A
laser or another suitable instrument is used to fragment the stone.
6.
Larger
fragments may be removed with specialized instruments.
7.
Very
small fragments may be left to pass naturally.
8.
A
temporary ureteral stent may be placed when necessary.
The exact technique depends on the
location and characteristics of the stone.
Preparation Before RIRS
Before the procedure, the patient
undergoes a medical assessment that may include:
- Review of ultrasound, CT, or other imaging.
- Blood tests.
- Urine analysis.
- Assessment for urinary infection.
- Evaluation of kidney function.
- Review of medications.
- Anesthesia assessment.
If a urinary infection is
identified, treatment may be required before the procedure.
Patients also receive specific
instructions regarding fasting, medications, and preparation for anesthesia.
Advantages of RIRS
For appropriately selected patients,
Flexible Ureteroscopy (RIRS) offers several potential benefits:
- No external surgical incision.
- Minimally invasive access to the urinary tract.
- Ability to reach different areas of the kidney.
- Effective laser fragmentation of stones.
- Treatment of selected kidney and ureteral stones during
one procedure.
- Relatively rapid recovery compared with traditional
open surgery.
The expected result depends on stone
size, location, composition, and the patient's individual anatomy.
Recovery
RIRS is often performed as a
short-stay or day procedure, depending on the patient's condition and the
complexity of treatment.
After the procedure, patients may
experience:
- Mild discomfort in the bladder or kidney area.
- A temporary need to urinate more frequently.
- Mild blood in the urine.
- Discomfort associated with a ureteral stent if one has
been placed.
These symptoms are usually
temporary.
Patients receive instructions about
medications, fluid intake, physical activity, and the timing of stent removal
when applicable.
Possible Risks and Complications
Although RIRS is minimally invasive,
complications can occur.
Possible risks include:
- Urinary tract infection.
- Bleeding.
- Temporary discomfort.
- Ureteral injury.
- Difficulty passing urine.
- Residual stone fragments.
- Need for an additional procedure.
- Stent-related symptoms.
- Rare ureteral narrowing or scarring.
The risk depends on the complexity
of the stone, anatomy of the urinary tract, and the patient's overall
health.
Follow-Up
Follow-up is important to determine
whether the stone has been completely cleared and to reduce the risk of
recurrence.
Depending on the case, follow-up may
include:
- Urine tests.
- Blood tests.
- Ultrasound.
- X-ray or CT imaging when appropriate.
- Assessment of residual fragments.
- Stone analysis.
- Metabolic evaluation for recurrent stone formers.
If a ureteral stent was placed, it
should be removed according to the urologist's instructions.
A Message to Our Patients
Kidney and ureteral stones can cause
significant pain and may sometimes lead to obstruction or urinary infection.
Flexible Ureteroscopy (RIRS) provides a minimally invasive option for treating
appropriately selected stones without an external incision. Using a flexible
ureteroscope and, when needed, laser technology, our urology specialists can
access the urinary tract and treat stones with precision.
Each patient is evaluated
individually so that the treatment approach can be selected according to the
size, location, and characteristics of the stone.
Frequently Asked Questions
What
is (RIRS)?
It is a minimally invasive
procedure in which a flexible ureteroscope is passed through the natural
urinary tract to reach the kidney and treat stones.
Is
RIRS surgery painful?
The procedure is generally performed
under anesthesia, so the patient does not feel the procedure itself. Temporary
discomfort, urinary urgency, or mild blood in the urine may occur afterward.
Can
RIRS remove kidney stones completely?
Many appropriately selected stones
can be successfully treated with RIRS. Larger or complex stones may require
more than one procedure.
Is
a laser used during RIRS?
Yes. A laser is commonly used to
fragment kidney or ureteral stones into smaller pieces that can be removed or
passed naturally.
How
long does recovery take after RIRS?
Recovery is generally relatively
quick. Many patients can resume normal daily activities within a few days,
depending on the procedure and their individual condition.
Will
I need a ureteral stent after RIRS?
A temporary stent may be placed in
some patients to facilitate urine drainage and healing. If used, the urologist
will provide instructions regarding its removal.
Can
kidney stones come back after RIRS?
Yes. RIRS removes existing stones
but does not necessarily prevent new stones from forming. Adequate fluid
intake, dietary measures, and medical evaluation can help reduce recurrence.