RIRS (Retrograde Intrarenal Surgery) at KIMS Secunderabad — Kidney Stones Treated Without a Single Incision
At a glance — RIRS specifics
- Full name: Retrograde Intrarenal Surgery — flexible ureteroscopy with laser lithotripsy
- What makes RIRS unique: Entirely through the natural urinary passage — urethra, bladder, ureter, and into the kidney. Zero skin incisions. Zero kidney punctures.
- Laser technology at KIMS: Holmium YAG laser (100W+) AND Thulium Fiber Laser (TFL) — the newest generation that pulverises stones to fine dust. Dual laser capability means the optimal system is matched to the stone type.
- Stone size treated: Primarily up to 2cm · Can be used for larger stones in selected patients (multiple sessions)
- Same-day discharge: Most RIRS patients at KIMS are discharged the same day or the following morning
- Pioneer status: KIMS was among the first centres in India to establish RIRS as a primary kidney stone treatment — building the volume and technique refinement that produces superior stone-free rates
- Metabolic stone clinic: RIRS removes the stone. The KIMS metabolic stone clinic identifies WHY the stone formed — and prescribes targeted prevention to stop it happening again
- Appointments: 040 - 44885000 · assistance@kimshospitals.com
What is RIRS and why has it become the preferred kidney stone treatment?
Retrograde Intrarenal Surgery is a minimally invasive procedure for removing kidney stones — performed entirely through the body's natural urinary passage, without making a single cut on the skin. A flexible ureteroscope — a thin, steerable fibre-optic telescope approximately 3mm in diameter — is passed through the urethra, into the bladder, up the ureter, and into the kidney. Once inside the kidney, a laser fibre is passed through the scope's working channel and used to fragment the stone into tiny particles. These particles are either collected with a small basket retrieval device or, when the Thulium Fiber Laser is used in dusting mode, reduced to sub-millimetre dust that flushes out spontaneously in the urine over the following days.
RIRS has become the preferred first-line treatment for kidney stones up to 2cm at KIMS Secunderabad — and is also used for a specific set of larger stones, anatomically challenging stones, and patients in whom Mini-PCNL carries elevated risk. The absence of any skin incision means zero wound-healing time, dramatically lower infection risk, shorter hospital stay, and faster return to normal activity compared to any puncture-based or open approach.
KIMS Secunderabad was among the first centres in India to establish RIRS as a primary kidney stone treatment modality, building the procedural volume and technique refinement — including the integration of Thulium Fiber Laser technology — that produces stone-free rates exceeding those achievable at centres with lower RIRS experience.
How RIRS is performed at KIMS — step by step
RIRS passes a flexible ureteroscope through the natural urinary passage into the kidney, then uses laser energy to fragment or dust the stone — entirely without skin incision. The entire procedure is performed under spinal or general anaesthesia:
| Stage | What happens |
|---|---|
| 1 — Pre-operative imaging | CT urography or non-contrast CT (NCCT KUB) performed to precisely locate the stone — its size, position, density (Hounsfield units), and relationship to the lower pole angle. This determines whether RIRS, ESWL, or Mini-PCNL is most appropriate. |
| 2 — Anaesthesia | Spinal or general anaesthesia — the patient is completely comfortable throughout. |
| 3 — Pre-stenting (when required) | In some cases (narrow ureter, large stone), a DJ stent is placed 1–2 weeks before RIRS to passively dilate the ureter and allow the larger-calibre digital ureteroscope to pass safely. Not always necessary. |
| 4 — Ureteroscope navigation | The flexible ureteroscope is passed under fluoroscopic guidance through the urethra, bladder, and ureter into the renal pelvis. The stone is located visually. |
| 5 — Laser lithotripsy | Holmium laser or Thulium Fiber Laser (TFL) is activated through the working channel. Holmium in fragmentation mode breaks the stone into small pieces for basket retrieval. TFL in dusting mode pulverises the stone to sub-0.5mm particles that flush out naturally — no retrieval needed, faster procedure. |
| 6 — Stone retrieval (when fragmented) | A nitinol basket retrieval device collects fragments for composition analysis — essential for metabolic stone clinic assessment. |
| 7 — DJ stent placement | A temporary DJ (double-J) ureteral stent is placed at the end of the procedure to protect the ureter from oedema and allow drainage during healing. Removed at 2–4 weeks under local anaesthetic in an outpatient appointment. |
| 8 — Recovery and discharge | Patient monitored for 4–6 hours post-procedure. Same-day discharge in most cases, or the following morning if spinal anaesthesia was used. |
Holmium vs Thulium Fiber Laser — KIMS uses both
The choice of laser in RIRS determines the technique used and the stone-free outcome. At most kidney stone centres in India, Holmium YAG laser is the only available system. At KIMS, both Holmium and Thulium Fiber Laser (TFL) are available — allowing the KIMS team to match the optimal laser to the stone characteristics:
Holmium YAG (100W+ at KIMS)
Pulsed energy fragments stone into 1–3mm pieces, retrieved by basket. Well-established, wide applicability. Best for: moderate to hard stones; when stone composition analysis from retrieved fragments is required; standard RIRS across all stone types.
Thulium Fiber Laser (TFL)
High-frequency pulses pulverise stone to sub-0.5mm dust that flushes out in urine — no basket retrieval needed. Faster procedure. Lower retropulsion. Best for: uric acid, struvite, and calcium oxalate monohydrate stones; complex anatomy where basket access is difficult; bilateral RIRS sessions.
Dual laser advantage
KIMS is one of very few centres in South India operating both systems. The appropriate laser is matched to the stone type, density, and anatomy — delivering the best possible stone-free outcome for each individual patient.
TFL dusting technique
Thulium Fiber Laser dusting is sometimes called the 'paint the stone away' technique — the stone is reduced to near-invisible dust in situ without the need to navigate a basket to retrieve pieces. Particularly advantageous in the lower pole of the kidney.
Pioneer experience
KIMS was among the first centres in India to establish RIRS as a primary kidney stone treatment. Flexible ureteroscopy has a steep learning curve — the stone-free rates achievable by experienced high-volume centres exceed those of lower-volume programmes by a clinically significant margin.
When is RIRS the right kidney stone treatment?
The choice between RIRS, ESWL (shock wave lithotripsy), and Mini-PCNL depends on stone size, location, density, composition, and patient factors. KIMS selects the treatment based on CT findings and patient-specific considerations:
| Stone scenario | Preferred treatment at KIMS | Reason |
|---|---|---|
| Stone ≤ 1cm in renal pelvis, upper or mid-calyx | ESWL first if stone density ≤ 900 HU · RIRS if ESWL failed or density > 900 HU | ESWL is non-invasive and avoids any anaesthesia — preferred when likely to work. High-density stones are ESWL-resistant. |
| Stone 1–2cm anywhere in kidney | RIRS — primary choice | Excellent stone-free rates with RIRS. Avoids skin puncture of Mini-PCNL. One session clears most stones in this range. |
| Stone in lower pole calyx (any size ≤ 2cm) | RIRS preferred over ESWL | ESWL has poor clearance for lower pole stones due to drainage anatomy. RIRS navigates directly to lower pole with flexible scope — especially effective with TFL dusting. |
| Stone 2–3cm | Mini-PCNL or RIRS (multiple sessions) | Stone burden exceeds single-session RIRS clearance in most cases. Mini-PCNL provides larger channel for more efficient clearance. |
| Stone > 3cm | Mini-PCNL or Standard PCNL | RIRS is insufficient for this stone burden — clearance rates fall significantly and multiple sessions increase risk and cost. |
| Anticoagulated patient (blood thinners) | RIRS | Mini-PCNL requires a skin puncture — bleeding risk is significantly higher with anticoagulation. RIRS involves no puncture and can be performed safely in anticoagulated patients in most cases. |
| Bilateral kidney stones | Bilateral RIRS in one session | Two separate kidney stone procedures under one anaesthetic — KIMS performs bilateral RIRS in selected patients, avoiding two separate admissions. |
| Solitary kidney | RIRS preferred | No skin puncture and lower risk of bleeding and kidney injury compared to Mini-PCNL — important when the remaining kidney must be protected absolutely. |
| Anomalous kidney (horseshoe, ectopic) | RIRS | The flexible ureteroscope can navigate the unusual collecting system anatomy of horseshoe and other anomalous kidneys where rigid PCNL access is impossible. |
| Stone in transplanted kidney | RIRS | Percutaneous access to a transplanted kidney is technically demanding and carries unique risks. RIRS is the preferred approach for stones in renal transplant recipients. |
RIRS vs other kidney stone treatments — honest comparison
| Feature | RIRS | Mini-PCNL | ESWL |
|---|---|---|---|
| Incision | None — through urethra | Small skin puncture (<1cm) into kidney | None — external shockwaves |
| Stone size | Up to 2cm (primary) | 2–4cm (primary) | Up to 1cm (best results) |
| Anaesthesia | Spinal or general | General or spinal | None or light sedation |
| Hospital stay | Same day / 1 night | 1–2 nights | Outpatient — no stay |
| Recovery | 2–3 days (desk work) | 3–5 days | Immediate |
| Lower pole stones | Excellent — flexible scope navigates directly | Good | Poor — low clearance rates |
| Anticoagulated patients | Safe — no puncture | Higher bleeding risk | Possible with caution |
| Bilateral same session | Yes — bilateral RIRS in one anaesthetic | Rarely | Not recommended |
| Metabolic stone analysis | Fragment sent for composition analysis | Fragment sent for composition analysis | Fragments may pass — analysis difficult |
| Available at KIMS | Pioneer centre — Holmium + TFL | Yes | Yes |
This comparison is honest, not promotional. Mini-PCNL remains more efficient for stones above 2cm. ESWL avoids anaesthesia entirely for suitable small stones. RIRS is the best option for men and women who have stones up to 2cm, lower pole or anatomically challenging stones, bilateral stones, or who are anticoagulated or have a solitary kidney — and for anyone who wants kidney stone removal without a single skin incision.
Why KIMS for RIRS?
Pioneer experience — volume matters in flexible ureteroscopy
KIMS was among the first centres in India to establish RIRS as a primary kidney stone treatment. Flexible ureteroscopy has a steep learning curve — the scope must navigate the kidney's intricate collecting system anatomy, and laser settings must be precisely adjusted for each stone's density and location. The stone-free rates achievable by experienced high-volume centres exceed those of lower-volume programmes by a clinically significant margin.
Holmium AND Thulium Fiber Laser — the newest technology standard
KIMS operates both the 100W+ Holmium laser and the Thulium Fiber Laser — the newest generation, available at very few centres in South India. TFL's dusting capability eliminates the need for fragment retrieval in suitable stones, reducing operating time and allowing bilateral same-session RIRS with manageable anaesthesia duration.
Metabolic stone clinic — addressing recurrence at its source
Stone recurrence without metabolic evaluation is 50% at 5 years. The KIMS metabolic stone clinic — combining stone composition analysis with blood and 24-hour urine metabolic profiling — provides the targeted prevention that turns a stone episode from a recurring problem into a managed metabolic condition.
Integrated nephrology — kidney function monitoring where needed
Patients with recurrent stones, a solitary kidney, or pre-existing CKD need kidney function monitoring after stone treatment. The KIMS nephrology team provides this monitoring concurrently with the urology stone programme, on the same campus.
RIRS specialists at KIMS Secunderabad
Frequently Asked Questions
RIRS (Retrograde Intrarenal Surgery) is a minimally invasive procedure for removing kidney stones — performed entirely through the natural urinary passage (urethra, bladder, ureter, and into the kidney) without any cuts or punctures on the skin. The procedure is performed under spinal or general anaesthesia, so the patient is completely comfortable during the operation. Post-operatively, the temporary DJ stent placed in the ureter commonly causes urinary frequency, mild urgency, and occasionally mild flank discomfort during urination — these are temporary and resolve completely when the stent is removed 2 to 4 weeks later. Most patients return home the same day and return to desk work within 2 to 3 days.
RIRS is the primary treatment choice at KIMS for kidney stones up to 2cm. For stones between 2 and 3cm, RIRS can be used but may require more than one session; Mini-PCNL is often more efficient. For stones above 3cm, Mini-PCNL or standard PCNL provides better stone-free rates in a single session. However, stone size is only one factor — location, density, anatomy, and patient factors all influence the choice. Lower pole stones, stones in anomalous kidneys, bilateral stones, and stones in patients on blood thinners or with a solitary kidney are often treated with RIRS even when Mini-PCNL would be the default choice for that size.
Both RIRS and Mini-PCNL are minimally invasive kidney stone treatments — but their approaches are opposite. RIRS passes through the natural urinary passage — no skin incision, no kidney puncture. Mini-PCNL makes a small skin puncture (less than 1cm) directly into the kidney under ultrasound and fluoroscopic guidance, passing a miniaturised working sheath into the stone-bearing calyx and fragmenting the stone directly. Mini-PCNL is more efficient for larger stone volumes (2–4cm) because the larger working channel allows faster stone clearance. RIRS is preferred for smaller stones, lower pole stones, patients who cannot tolerate a kidney puncture (anticoagulated, solitary kidney), and anatomically unusual kidneys.
Most stones under 1.5cm are cleared completely in a single RIRS session at KIMS, particularly when the Thulium Fiber Laser is used in dusting mode. For stones approaching 2cm, a small residual fragment rate exists and an imaging follow-up at 4 to 6 weeks confirms clearance. For complex or multiple stones, staged procedures may occasionally be needed — the KIMS team discusses the expected number of sessions at the pre-operative planning appointment. Bilateral stones (stones in both kidneys) can sometimes be treated in a single session of bilateral RIRS — both kidneys are treated sequentially in one anaesthetic, avoiding the need for two separate admissions.
A DJ (double-J) ureteral stent is a small, soft plastic tube placed between the kidney and the bladder at the end of the RIRS procedure. It serves two purposes: it maintains the ureter open during the post-operative period when swelling from the laser treatment may temporarily narrow the ureter; and it ensures urine drains freely from the kidney even if a small stone fragment initially blocks the ureter before it passes. The stent is removed at 2 to 4 weeks at a routine outpatient appointment at KIMS under local anaesthetic gel applied to the urethra — no theatre, no general anaesthesia. Stent removal takes approximately 5 minutes.
Without investigation and treatment of the underlying metabolic cause, kidney stone recurrence rates are approximately 50% within 5 years — regardless of whether the stone was removed by RIRS, PCNL, or any other technique. RIRS removes the stone; it does not address why the stone formed. The KIMS metabolic stone clinic — part of the standard post-RIRS programme — performs stone composition analysis, blood tests, and 24-hour urine metabolic profiling to identify the specific metabolic risk factor (hypercalciuria, hyperuricaemia, low urinary citrate, hyperoxaluria). A targeted prevention programme is then prescribed — dietary changes, adequate hydration, and specific medications (potassium citrate, allopurinol, thiazide diuretics) — that can reduce recurrence risk by 80 to 90%.
Yes — RIRS is one of the safest kidney stone treatments available for patients on anticoagulation (warfarin, apixaban, rivaroxaban, clopidogrel). Because RIRS involves no skin incision and no kidney puncture, the bleeding risk associated with anticoagulation is significantly lower than for Mini-PCNL or standard PCNL. The approach used at KIMS for anticoagulated patients is case-by-case: for patients on blood thinners for a critical indication (mechanical heart valve, recent coronary stent), the KIMS team coordinates with the treating cardiologist to determine whether temporary anticoagulation interruption is safe, or whether RIRS can be performed with the anticoagulation maintained at a modified level.
KIMS Secunderabad — a pioneer RIRS centre in India operating both Holmium YAG (100W+) and Thulium Fiber Laser for stone dusting — with the highest-volume flexible ureteroscopy programme in Secunderabad. The KIMS metabolic stone clinic provides comprehensive post-RIRS recurrence prevention, combining stone composition analysis with 24-hour urine metabolic profiling. Nephrology integration for patients with pre-existing CKD or solitary kidney. NABH and NABL accredited. Aarogyasri, CGHS, and EHS empanelled.