RIRS - Laser Kidney Stone Removal

RIRS stands for Retrograde Intrarenal Surgery - a keyhole procedure to remove kidney stones using a flexible ureteroscope passed through the natural urinary passage (urethra → bladder → ureter → kidney). No cuts are made anywhere on the body. A laser fibre passed through the scope pulverises the stone into fine dust that washes out naturally. It is the preferred technique for kidney stones between 1 cm and 2 cm, and is often chosen for stones larger than 2 cm in patients who want to avoid a skin puncture (PCNL).

ESWL uses shock waves from outside the body to break stones into fragments that then need to pass through the ureter. RIRS uses a laser inside the kidney to vaporise the stone. RIRS has a higher stone-free rate (85–95% vs 70–80% for ESWL for 1–2 cm stones), works on all stone types including hard calcium oxalate monohydrate and cystine stones, and does not require the patient to pass fragments. ESWL is non-invasive but less effective for harder stones, lower-pole stones, and stones above 1.5 cm.

RIRS is performed under general or spinal anaesthesia, so you are completely pain-free during the procedure. Post-operatively, most patients have mild burning when urinating and some blood-tinged urine for 2–5 days. A ureteral stent (DJ stent) is usually left in place for 1–3 weeks, which can cause some discomfort - a dull ache in the side, frequent urination, and occasionally blood in the urine. The stent is removed in clinic under local anaesthesia or light sedation.

The procedure itself takes 45–90 minutes depending on stone size, location, and hardness. Hospitalisation is typically overnight (one night). Most patients are discharged the following morning. You can return to desk work in 3–5 days and full activity in 2–3 weeks (after stent removal).

For stones 1–2 cm: stone-free rates of 85–95% are reported after a single session. For stones larger than 2 cm: a single session achieves stone-free status in approximately 70–85% of cases; a second session may be needed. Stone-free is defined as no fragments larger than 2–3 mm on CT scan at 4 weeks. RIRS for lower-pole stones - traditionally difficult to clear with ESWL - achieves excellent results with modern flexible scopes.

In most cases, yes - a double-J (DJ) stent is placed at the end of the procedure to keep the ureter open, allow any remaining fragments to pass, and prevent blockage from post-operative swelling. The stent is removed 1–3 weeks after surgery in a brief clinic procedure (ureteroscopy under local or light sedation, taking about 5 minutes). A small number of straightforward cases (very small residual, no swelling) can be managed without a stent, which Dr. Nitin will discuss with you.

Yes. RIRS for kidney stones is covered under CGHS, ECHS, Ayushman Bharat, and most private health insurance policies. Apollo Hospital Gurugram is empanelled for all these schemes. Pre-authorisation is typically required for elective procedures. The hospital's insurance desk will assist with paperwork. Bring your health card or policy documents when you come for the pre-operative consultation.