RIRS — تفتيت حصوات الكلى بالمنظار الليزر | د. سامر مرسيRIRS — Flexible Ureteroscopy & Laser Lithotripsy | Dr. Samer Morsy

What is RIRS?

RIRS (Retrograde Intrarenal Surgery) uses a digital flexible ureteroscope advanced retrograde through the urethra, bladder, and ureter to reach the renal collecting system directly. A holmium laser fibre is passed through the working channel to pulverise stones to dust, which then passes spontaneously with urine. No skin incision is made at any point.

Indications

• Renal stones 5 mm – 2 cm
• ESWL failure or unfavourable anatomy for shock wave
• Lower pole calyceal stones
• Patients on anticoagulation (no puncture required)
• Stones in transplant kidneys or horseshoe kidneys
• Multiple small stones — single-session clearance

Outcomes

Recovery

A temporary double-J ureteric stent is usually placed and removed 1–2 weeks later under local anaesthesia. Discharge same day or next morning. Hydration (≥2 L/day) is important. Imaging review at 4 weeks confirms stone-free status.

Frequently Asked Questions — RIRS

What is the maximum stone size treatable with RIRS in one session?

RIRS reliably clears stones up to 2 cm in a single session with stone-free rates exceeding 95%. Stones between 2–3 cm may require two sessions, and PCNL is generally preferred for stones clearly larger than 2 cm or complete staghorn calculi. The optimal approach is determined after reviewing CT imaging, stone composition, and location within the collecting system.

Is a JJ stent always necessary after RIRS?

In most cases, yes. A temporary double-J ureteric stent is placed at the end of the procedure to facilitate passage of stone fragments and prevent ureteric obstruction from post-operative oedema. The stent is removed 1–2 weeks later as an outpatient procedure under local anaesthesia. Some patients experience mild stent-related discomfort (urinary frequency, flank ache) which resolves on removal.

Can RIRS treat stones in multiple sessions?

Most stones up to 2 cm are cleared in one session. Larger stones or those in difficult calyceal positions may require a staged second look procedure. The expected number of sessions is discussed pre-operatively based on CT findings. Dr. Morsy aims for single-session clearance using the dusting technique to minimise the need for repeat procedures.

Is RIRS safe for patients on anticoagulation?

RIRS is among the safest stone treatments for anticoagulated patients because no skin puncture or incision is required. Anticoagulation may still be temporarily bridged or paused pre-operatively in coordination with the prescribing physician, but the interruption period is significantly shorter than for PCNL. This makes RIRS the preferred option for patients on warfarin, DOACs, or aspirin who cannot safely stop medication.

When can patients return to work after RIRS?

Most patients return to desk work within 1–2 days. Mild discomfort from the JJ stent (urinary frequency, occasional flank discomfort) is common but manageable. Full physical activity is resumed after stent removal at 1–2 weeks post-procedure. Patients are advised to maintain high fluid intake (≥2 L/day) throughout recovery.