Flexible Ureteroscopy
(RIRS)
Advanced laser treatment for kidney stones performed without cuts or stitches, ensuring minimal discomfort and quicker recovery.
What is Flexible Ureteroscopy (RIRS)?
Retrograde IntraRenal Surgery (RIRS) is an advanced, minimally invasive technique to treat kidney stones using a thin, flexible ureteroscope passed through the body's natural urinary passage — the urethra and ureter — directly into the kidney. No incision is made in the skin.
Flexible Ureteroscope
A hair-thin, flexible fibre-optic instrument that bends to reach every corner of the kidney, including the lower pole — an area that is difficult to access with rigid instruments or shock wave therapy.
Holmium Laser Lithotripsy
A high-powered holmium:YAG laser is passed through the scope to fragment stones into dust-sized particles that pass naturally with urine, eliminating the need to retrieve large fragments.
No Cuts, No External Incision
The entire procedure is performed through the natural urinary tract under general or spinal anaesthesia. There are no wounds to heal, no drains, and no external stitches — recovery is significantly faster.
45–90 Minutes
The procedure typically takes 45 to 90 minutes depending on stone burden, position, and hardness. A temporary ureteral stent may be placed at the end of surgery and removed one to two weeks later.
How Flexible Ureteroscopy is Performed
A structured, precise sequence ensures the stone is completely cleared while the kidney and urinary tract are protected.
Anaesthesia
General or spinal anaesthesia is administered. The patient lies in the lithotomy position. Prophylactic antibiotics are given.
Scope Passage
The flexible ureteroscope is advanced through the urethra and bladder, up the ureter, and into the kidney under fluoroscopic and direct vision guidance.
Stone Localisation
The scope explores all calyces of the kidney. Each stone is identified and positioned for laser treatment. X-ray confirms complete stone identification.
Laser Fragmentation
The holmium laser pulverises the stone to dust. Larger fragments may be retrieved with a basket. The stone is thoroughly cleared.
Stent & Recovery
A JJ ureteral stent is usually inserted to assist healing and drainage. The patient is discharged the same day or the following morning.
Advantages of Flexible Ureteroscopy Over Other Treatments
RIRS has become the procedure of choice for most kidney stones in contemporary urological practice, offering advantages that other modalities cannot match.
No external incision
Performed entirely through the natural urinary passage — no skin wound, no scar, no drain.
Access to all parts of the kidney
The flexible tip reaches lower pole stones and stones in difficult locations that ESWL and semi-rigid ureteroscopy cannot effectively treat.
Higher stone-free rates
RIRS achieves stone-free rates of 85–95% for stones up to 2 cm — superior to ESWL for most stone compositions and locations.
Same-day discharge possible
Most patients go home the same day or the following morning, with normal activity resuming within 3–5 days.
Works for hard stones
The holmium laser effectively fragments all stone compositions — calcium oxalate monohydrate, cystine, and brushite — that resist shock wave fragmentation.
Safe for anticoagulated patients
Unlike percutaneous surgery, RIRS does not require needle puncture of the kidney and can often be performed in patients on blood thinners with appropriate precautions.
Simultaneous stone analysis
Fragments can be retrieved for formal stone composition analysis — guiding dietary changes and medications to prevent future recurrence.
Minimal blood loss
There is virtually no blood loss associated with flexible ureteroscopy compared to open or percutaneous surgery.
RIRS vs. Other Kidney Stone Treatments
How flexible ureteroscopy compares to the alternatives: ESWL (shock wave), semi-rigid ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL).
| Feature | RIRS (Flexible URS) | ESWL | Semi-rigid URS | PCNL |
|---|---|---|---|---|
| No incision | ✓ | ✓ | ✓ | ✗ |
| Reaches lower pole stones | ✓ | Limited | ✗ | ✓ |
| Suitable for hard stones | ✓ | ✗ | ✓ | ✓ |
| Stones up to 2 cm | ✓ | Limited | Ureter only | ✓ |
| Day care / same-day discharge | ✓ | ✓ | ✓ | ✗ |
| Stone-free rate (≤2 cm) | 85–95% | 50–75% | 85–90% | >95% |
When is RIRS Recommended?
Flexible ureteroscopy is the preferred treatment in a wide range of clinical scenarios where other techniques would be less effective or less appropriate.
Are You a Candidate for RIRS?
Dr. Anand Utture evaluates each patient individually based on stone size, location, composition, and overall health to determine the most appropriate treatment.
Kidney stone 5 mm to 2 cm
Stones in this size range are ideally suited to RIRS — large enough to require treatment but small enough to be dusted effectively with the holmium laser.
Stone in difficult location
Lower pole, isthmus (horseshoe kidney), or calyceal diverticulum — locations that the flexible scope can reach but other methods cannot.
Recurrent stone formers
Patients with a history of multiple stones who also benefit from simultaneous stone analysis to guide long-term prevention strategies.
Very large stones (>2 cm)
Stones larger than 2 cm are usually better managed with percutaneous nephrolithotomy (PCNL) which has higher stone-free rates for large stone burden.
Diagnosed with a kidney stone? Consult Dr. Anand Utture in Mumbai.
Dr. Anand Utture offers flexible ureteroscopy (RIRS) with holmium laser for kidney stones — scarless, precise, and with minimal recovery time. Serving patients across Mumbai, Thane, and Maharashtra.
Frequently Asked Questions — Flexible Ureteroscopy (RIRS) in Mumbai
What is Flexible Ureteroscopy (RIRS)?
RIRS stands for Retrograde IntraRenal Surgery. It is a minimally invasive procedure to treat kidney stones using a thin, flexible scope passed through the natural urinary tract — without any cuts or external incisions. A holmium laser is used to break the stone into fine dust that passes out naturally with urine.
How large a kidney stone can RIRS treat?
RIRS is particularly effective for kidney stones up to 2 cm. It can also be used for selected stones larger than 2 cm in multiple sittings or in patients where percutaneous surgery would carry higher risk. Dr. Anand Utture will determine the optimal approach based on your stone size, location, and composition.
Is RIRS painful?
RIRS is performed under general or spinal anaesthesia, so there is no pain during the procedure. There may be mild discomfort from the temporary ureteral stent placed at the end of surgery — this is removed after one to two weeks in clinic. Most patients find the procedure and recovery more comfortable than they anticipated.
How long is recovery after RIRS?
Most patients are discharged the same day or the following morning. Normal activity — including desk work — is typically resumed within 3–5 days. Strenuous physical activity and heavy lifting should be avoided for two weeks after stent removal.
What is the ureteral stent and why is it needed?
A JJ ureteral stent is a small, flexible tube placed inside the ureter to keep it open and allow the kidney to drain freely while any post-procedure swelling settles. It is removed under local anaesthesia or sedation as an outpatient procedure one to two weeks after surgery.
Is RIRS better than shock wave lithotripsy (ESWL)?
For most kidney stones, RIRS achieves significantly higher stone-free rates than ESWL — particularly for lower pole stones, hard stone compositions (cystine, calcium oxalate monohydrate), and stones that failed prior shock wave treatment. ESWL may be preferred for small, soft stones in favourable locations in certain patients. Dr. Anand Utture will advise which modality is best for your specific stone.