Ghatkopar (East), Mumbai)
RIRS Surgery in Mumbai - Retrograde Intrarenal Surgery
Zero External Incision | Flexible Ureteroscopy | Day Surgery Available
When kidney stones form deep inside the renal collecting system – too inaccessible for standard ureteroscopy, too small for PCNL – RIRS surgery in Mumbai at Shree Hospitals is the answer. Retrograde intrarenal surgery uses a thin, steerable, flexible ureteroscope that bends and rotates to navigate every recess of the kidney from within, guided by live camera vision and powered by a holmium laser to dust stones into particles fine enough to pass in urine.
The entire procedure is performed through the body's natural urinary passage - no cuts, no punctures, no scars. For patients with kidney stones up to 2cm who want the fastest return to normal life, RIRS is the gold standard endoscopic choice.
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Quick facts
Type & Duration: Retrograde intrarenal surgery with flexible ureteroscopy; 45 to 90 minutes
Hospital Stay: Day surgery or 1-night admission
Recovery Time: Return to daily activity in 1 to 2 days; full recovery in 1 week
Type of Anaesthesia: General or spinal anaesthesia
Type of Surgery: Endoscopic - natural orifice, zero external incision
Type of Assistance: Pre-operative CT stone mapping, RIRS with laser dusting, post-procedure stent management, stone analysis for recurrence prevention
What is RIRS (Retrograde Intrarenal Surgery)?
Retrograde intrarenal surgery is the most technically advanced approach to treating kidney stones endoscopically. Where a standard semi-rigid ureteroscope can only access the ureter and the lower pole of the kidney, a flexible ureteroscope - used in RIRS - can deflect up to 270 degrees, reaching every part of the renal collecting system including the upper pole, the infundibula, and the renal pelvis, regardless of how anatomically complex the kidney's architecture is.
The word "retrograde" refers to the direction of approach: against normal urine flow - upward from the urethra, through the bladder, and into the kidney. Once the flexible ureteroscopy scope is positioned at the stone, a holmium laser fibre is advanced through the instrument's working channel and fired at the stone repeatedly, vaporising it into a fine dust (stone dusting technique) or breaking it into small fragments retrievable with a nitinol basket. Dusting is preferred for hard, calcium-based stones - it eliminates fragments entirely, leaving nothing to pass and nothing to cause future obstruction.
At Shree Hospitals, RIRS is performed on a dedicated flexible endoscopy system with single-use or reprocessed scopes to maintain optic quality - because image clarity is directly linked to surgical precision. The renal pelvis stones targeted in our programme range from incidentally discovered 8mm calculi to symptomatic 2cm stones causing recurrent colic or obstruction.
Which Stones Is RIRS Best For?
- Kidney stones between 1cm and 2cm in size
- Stones in difficult locations - upper pole, infundibulum, calyceal diverticulum
- Patients with a solitary kidney where nephrostomy is too high risk
- Stones in horseshoe kidneys or other anatomical variants
- Recurrent stones in patients preferring no percutaneous approach
- Multiple small stones in different calyceal groups
Is RIRS Right for You?
- Renal pelvis stones or calyceal stones up to 2cm confirmed on CT
- Failure of ESWL (external shockwave treatment) or contraindication to it
- Patient preference for no external incision or skin puncture
- Normal or mildly dilated ureter allowing safe scope passage
- No uncorrected coagulopathy or active urinary infection
- Suitable for day surgery - fit for short general or spinal anaesthesia
RIRS Advantages Over Other Stone Techniques
- No skin incision - unlike PCNL which requires a flank puncture
- Accesses all parts of the kidney - unlike semi-rigid ureteroscopy which cannot
- No radiation beyond CT staging - flexible ureteroscopy uses minimal fluoroscopy
- Faster recovery than PCNL - no nephrostomy tube, no prolonged hospital stay
- Superior access to difficult locations - upper pole, horseshoe anatomy
- Safe in anticoagulated patients with dose adjustment
A stone inside your kidney is not a stone you have to live with - or wait for until it causes a crisis. RIRS removes it completely, without a single external incision.
The consultation takes an hour. The procedure often takes less.
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Our Approach to RIRS at Shree Hospitals
RIRS is one of the most technique-sensitive procedures in urology - the quality of the scope, the surgeon's deflection control, and the laser stone fragmentation strategy all directly affect the stone-free rate.
Our approach is built on superior equipment, meticulous pre-operative planning, and surgical execution that does not compromise on thoroughness.
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Pre-Operative CT Stone Characterisation
Every RIRS patient undergoes non-contrast CT KUB to identify stone number, exact calyceal location, density (Hounsfield units), and the infundibulo-pelvic angle - which determines access difficulty. Stones with high density (above 1000 HU) are more resistant to laser dusting; lower energy pulse settings and longer procedure time are planned accordingly.
Ureteral Access Sheath for Optimal Scope Function
A ureteral access sheath is placed in most RIRS procedures - a thin outer tube that maintains open access to the ureter and allows repeated scope passage, irrigation outflow, and continuous vision clarity. Its use reduces intrarenal pressure, minimises the risk of pyelovenous backflow (which can introduce bacteria into the bloodstream), and significantly extends the working life of the flexible scope during a single case.
Holmium Laser Dusting Protocol Our laser stone fragmentation
Protocol favours a high-frequency, low-energy dusting setting for stones up to 1.5cm - reducing stones to particles under 0.3mm that pass silently in urine. For larger or harder stones, a combination of dusting and fragmentation with basket retrieval is used. The goal is zero residual fragments at procedure end.
Post-Operative Stent Placement & Stone Analysis
A ureteral stent is placed in virtually all RIRS cases to prevent post-operative oedema from causing ureteric obstruction. Stent removal is arranged at 1 to 2 weeks. Any retrieved stone material is sent for compositional analysis - identifying calcium, uric acid, oxalate, or other constituents - forming the basis for individualised recurrence prevention advice.
Top RIRS Surgeons in Mumbai
Retrograde intrarenal surgery is a subspecialty skill within urology - not every urologist performs it at high volume.
Our endourology team at Shree Hospitals has dedicated significant practice to flexible ureteroscopy and laser stone fragmentation, managing complex bilateral and recurrent stone disease that challenges even experienced endourologists.
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Dr. Shyam Mohan
Robotic Urological Surgery, Uro-Oncology
Dr. Alap Mehendale
Urologist, Andrologist, Kidney Transplant Surgeon
Related Stone Treatments at Shree Hospitals
The best stone treatment depends on the stone's size, location, and density. RIRS is ideal for medium-sized kidney stones - but for other presentations, our programme offers the complete range
Laser Kidney Stone Surgery
Umbrella term for all endoscopic laser stone treatments; RIRS is the kidney-specific technique.
PCNL Surgery
For stones larger than 2cm or staghorn calculi where RIRS cannot achieve adequate clearance.
Ureteroscopy (URS)
Semi-rigid scope for ureteric stone in the lower or mid ureter - faster, simpler procedure.
ESWL
Shockwave treatment for suitable stones; no anaesthesia required, fully outpatient.
Step by Step Process of RIRS Surgery
Step 1 - Imaging Review, Consent & Pre-Op Preparation
CT KUB is reviewed in detail - stone location within specific calyces is mapped, infundibulo-pelvic angle measured, and stone density noted. Urine culture is checked; any infection is treated before surgery. Anaesthetic assessment is completed. You arrive fasted on the morning of surgery. Your surgeon walks through the procedure, stent plan, and post-operative expectations.
Step 2 - Anaesthesia, Positioning & Ureteral Dilation
General or spinal anaesthesia is administered. You are positioned in the lithotomy position. A guidewire is placed up the ureter under fluoroscopic guidance. A ureteral access sheath is advanced over the wire to the level of the ureteropelvic junction - dilating the ureter gently to allow comfortable passage of the flexible scope. The scope is then introduced through the sheath and advanced into the kidney.
Step 3 - Flexible Scope Navigation & Laser Stone Fragmentation
Under direct camera vision, the flexible ureteroscope navigates through each calyceal group systematically - identifying all stones mapped on pre-operative CT. The holmium laser fibre is deployed and fragmentation begins. Stones are dusted sequentially; any retained fragments above 2mm are retrieved with a nitinol basket before the scope is withdrawn. The entire collecting system is surveyed at the end to confirm clearance.
Step 4 - Stent Placement, Recovery & Follow-Up
A ureteral stent is placed under direct vision. The ureteral access sheath is removed. You are transferred to recovery and monitored for 1 to 2 hours. Most patients are discharged the same day or the following morning. The stent is removed in clinic under local anaesthesia at 1 to 2 weeks. Post-operative CT at 4 to 6 weeks confirms stone-free rate and identifies any residual fragments requiring additional treatment.
Patient Questions About RIRS Surgery
Is RIRS suitable for very hard kidney stones?
Stone hardness, measured by CT Hounsfield units, directly affects laser stone fragmentation efficiency. Stones above 1000 HU - typically calcium oxalate monohydrate - are harder to dust and may require longer operative time or a more fragmentation-based approach. They are not a contraindication to RIRS, but they do influence the procedure's duration and the likelihood of achieving complete clearance in a single session. Your surgeon will advise based on your specific stone density data from pre-operative CT.
What happens if not all the stone is removed in one RIRS session?
If residual fragments are identified on post-operative CT - particularly fragments above 4mm - a second RIRS session or a change in approach (such as adding ESWL for peripheral fragments) may be recommended. Residual fragments under 4mm are typically managed expectantly as they often pass spontaneously. Our surgeons discuss the likely need for staged procedures pre-operatively based on stone size and CT anatomy, so patients are not surprised by this possibility.
How soon can I return to work after RIRS?
The vast majority of patients return to desk-based or sedentary work within 1 to 2 days of retrograde intrarenal surgery. The ureteral stent causes urinary frequency and mild discomfort that is present for the duration of stent residence - typically 1 to 2 weeks. Stent removal produces rapid symptom relief. Manual workers or those in physically demanding roles are advised to wait until after stent removal and a period of light activity confirmation - typically 2 to 3 weeks from the procedure date.
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