RIRS stands for Retrograde Intrarenal Surgery :- Retrograde intrarenal surgery (RIRS) is a procedure mostly used for removal of kidney stones with help of Flexible Ureteroscopes, both fiberoptic & digital ( Chip on the tip ), Holmium laser, Access Sheaths, tipless baskets etc through natural urinary passage.

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RIRS Procedure consists of passing the flexible ureteroscope through natural urinary passage either directly or by backloading or through access sheath placed in the ureter. The scope is then placed in the collecting part of the kidney called Pelvicalyceal System. The stone is then visualized & fragmented with a holmium laser fibre. The fragments so formed are basketed & removed. Stone can alternatively be dusted with holmium laser. After the dusting of stone or removal of stone, a D J stent is usually placed in the Kidney & Ureter. This stent is later removed after few weeks.

RIRS is a no hole, no cut, Day Care, the Safest procedure for Removal of Kidney Stones. R P Stone Clinic is a Pioneer Center for Removal of Kidney Stones by RIRS in India

RIRS have several advantages over other techniques of stone removal like Percutaneous Nephrolithotomy ( PCNL ), Open Stone Surgery ( OSS ) & Extracorporeal Shock Wave Lithotripsy ( SWL).

RIRS is a Daycare procedure for removal of Kidney Stones. RIRS can now be performed for large Kidney Stones. R P Stone Clinic Hospital even removes Staghorn Kidney Stones by RIRS. RIRS is also a safe procedure for Obese patients. RIRS can also be performed safely in patients on Anticoagulants & in Patients with Bleeding diathesis. RIRS could be a preferred method for removal of Kidney stones in Horseshoe Kidneys & other anomalous Kidneys. Since there is no hole, no cut on the human body, the patient can go back to work early. RIRS is much less invasive when compared to open stone surgery & percutaneous nephrolithotomy (PCNL).

Our Journey through RIRS Surgery

It was in 1991 when I first encountered a flexible ureteroscope which I bought from a hospital in Banglore who had imported all such equipment from Germany. The owner of the hospital was a radiologist and unfortunately the Urologist employed by him to use all this equipment left him. This flexible ureteroscope was 11 Fr. and did not have any deflection. I could use this ureteroscope purchased for over Rs. 1 Lakh only in two cases just to see a stone in the ureter. But the joy I had in these two cases was much more than Rs. 1 Lakh which I spent on purchasing this ureteroscope. After using this scope in two cases, I broke this scope. Till 1998, I did not get any further flexible ureteroscope to use when I visited Germany and I had detailed discussions with Engineers from Richard Wolf GmbH and a Urologist named Dr Andreas Gross who later became a close friend of mine and visited us in Panipat and other parts of India several times. It was in 1998 when I actively started using flexible ureteroscopy at R P Stone Clinic, Panipat. It was in that year I organised a workshop on Rigid and Flexible Ureteroscopy at our Clinic under the aegis of North Zone Chapter of Urological Society of India. Dr Andreas Gross from Germany, Dr David Albala from America and leading Urologists from India participated in this workshop. For the first time in India, the use of Flexible Ureteroscope for Kidney Stones was demonstrated in this workshop. After this a large scale international workshop on RIRS was organised by Urological Society of India at R P Stone Clinic, Panipat with Dr Pawan Gupta as its organizing secretory in the year 2011. This Workshop was attended by around 200 Urologists from all over the Country and Abroad. Eight Live Cases of RIRS Surgery were demonstrated in this workshop, four operations were performed by Dr Pawan Gupta and four by Dr Andreas Gross. Following this, another major workshop was organised at R P Stone Clinic by Dr Pawan Gupta in 2012. After this regular training programs on RIRS surgery were conducted at this Clinic. With the result, today even Staghorn Stones are being removed by RIRS Surgery at our Kidney Stone Hospital.

Since 1998, Dr. Pawan Gupta has been regularly practicing this technology at R P Stone Clinic, Panipat for removal of Kidney Stones. We have been treating patients of kidney stones from India and Abroad with this technology popularly known as RIRS Surgery. We have treated thousands of Kidney Stones with RIRS Surgery since 1998.

From Flexible Ureteroscopes with no deflection, we have had a long journey through Fiberoptic Flexible Ureteroscopes with 180 degree deflection with instrument channels to Fiberoptic Flexible Ureteroscopes with 270 degree deflection to Digital (Chip on the Tip) Flexible Ureteroscopes with 275 degree deflection.

Armamentarium today available with R P Stone Clinic, Panipat for RIRS
Surgery is Huge and is shown below

Digital (Chip on the Tip) Flexible Ureteroscopes at R P Stone Clinic, Panipat

Digital (Chip on the Tip) and Fiberoptic Flexbile Ureteroscopes available at R P Stone Clinic, Panipat

Numerous Semirigid Ureterorenoscopes available at R P Stone Clinic, Panipat

Holmium Lasers at R P Stone Clinic, Panipat

Heap of Used Ureteral Access Sheaths at R P Stone Clinic, Panipat

Heap of Used Baskets at R P Stone Clinic, Panipat

RIRS Surgery

Armamentarium today available with R P Stone Clinic, Panipat for RIRS Surgery is Huge and is shown below

Armamentarium today available with R P Stone Clinic, Panipat for RIRS
Surgery is Huge and is shown below