Retrograde Intrarenal Surgery (RIRS) is a surgical procedure commonly employed for treating kidney stones. This technique permits the extraction of stones using a flexible ureteroscope and does not require any incisions to be performed. While RIRS is indeed effective and safe, it does have some drawbacks. If you are considering this treatment, understanding its potential disadvantages can help you make an informed decision.
Possible Disadvantages of RIRS Kidney Stone Treatment
Below are the possible Disadvantages of RIRS:-
1. Not Recommended for Patients With Large Stones
RIRS is optimal for small to medium-sized stones of the kidney, which are usually stones 1 to 2 cm in size. In treating larger stones, multiple sessions are required which are considerably longer than percutaneous nephrolithotomy (PCNL), which are far more effective for bigger stones.
2. Increased Possibility for Fragmented Stones to Reappear In Some Cases
Although RIRS effectively obliterates the stones, there will always ever be a chance that some fragments of the stone may remain undetected within the kidneys. If these particles are not ejected willingly, they do have the potential to transform into another stone over time. Patients who are suffering from metabolic disorders or chronic stone formation tendencies will have to be monitored regularly.
3. Injury to Ureters and Stricture Development
The operation entails the deployment of a ureteroscope from the urethra and through the ureter into the kidney region. There is possible injury of the ureter that results in edema, injury, or, very infrequently, ureteral strictures i.e. narrowing of the ureter. Some Ureteral stricture may need some alternative measures in order to enable passage of urine in a usual way.
4. Chance of Urinary Tract Infection (UTI)
RIRS has instruments that are passed through the urinary system, which makes infection prevalent in these cases. To some extent, RIRS is concerning for urinary infections. Infections post the procedure could still present with some discomfort and fever, and pain in some patients.
5. Hematuria (Blood in Urine) for a Short While
In specific patients undergoing RIRS, it not uncommon to see blood in the urine (hematuria) a few days post surgery. This moderate reaction tends to run its course with no treatment, but there can be rare cases of hemorrhaging where patients need to be treated medically.
6. Complications from Anesthesia
RIRS is always done with either general or spine anesthesia being given. Modern anesthesia is more refined and safe nowadays, but patients can still exhibit nausea and vomiting, dizziness, or allergic reactions. These effects may occur to patients suffering from severe pre-existing medical conditions. Discussing the anesthesia is important before like conditions with the doc.
7. Justification for DJ Stent Usage
Additionally, following RIRS, it is common to place a DJ stent to promote urine drainage and to prevent back pressure edema within the ureter. Although this stent is typically removed after a few weeks, in some patients, removal dummy stent is associated with considerable discomfort, pain, and an urgent need to pass urine.
8. Higher than Other Techniques Cost
RIRS is more costly than SWL or PCNL for reasons such as use of sophisticated laser machines. Even though the patient is less likely to suffer with longer term consequences, recovery takes time, and for some patients, expense can be a major concern.
9. Limited Effectiveness Against Tough Stones
Kidney stones that are classified as tough include those that are made up of cystine or calcium oxalate monohydrate. In such cases, laser fragmentation will not resolve the stone and additional treatment sessions will be required.
Why Should We Still Go for RIRS?
No procedure is without potential risks and drawbacks, RIRS, however, remains one of the most well-liked methods for treating kidney stones because it does offer a number of benefits.
1. No surgical incision and is Minimally Invasive
Whereas PCNL involves a slight incision in the kidney area, RIRS is fully Endoscopic. This endoscopic method is conducted through the natural urinary tract which enhances healing and reduces trauma to the body.
2. Reduced Pain and Quick Recovery
Pain after surgery is minimal or non existent due to no incisions and normal life can be resumed within a matter of days. This makes RIRS an ideal procedure for those who are looking to recover quickly.
3. Effective for Small to Medium Stone Size: High Success Rate
RIRS is very effective in treating stones measuring a maximum of 2cm. It is effective because of the laser technology used which makes precise fragmentation of the stones simpler.
4. Patients Who Cannot Have PCNL, Can
RIRS is the safest form of surgery for patients who have bleeding disorders, obesity, or conditions that are not conducive to having PCNL or open surgery. It is also better for elderly patients or those with multiple co-morbidities.
5. Less Possibility of Complications Compared to Open Surgery
As compared to open surgery, RIRS is remarkably less invasive which helps mitigate complications like severe bleeding and organ injuries.
6. Efficient for Difficult Locations Where Stones Could Be Found
Compared to SWL, RIRS is far more superior as the latter can access stones that are located within lower portion of the kidney, calyx. The range of the device’s scope enables retrieval of stones that would otherwise be impossible to get through SWL.
7. Can Be Done As A Daycare Procedure
A good number of people can leave the same day, or at worst, the next day which means they do not have to stay in the hospital for extended periods of time.
Although there are some limitations of RIRS, its benefits prevail over the downsides for most patients. It is a preferred method for kidney stone removal due to its minimally invasive technique for treating stones, expedient recoveries, and high success rates.
Whether or not to use RIRS, depends on stone size, location as well as the overall health of the patient. An experienced urologist can help in determining if RIRS can provide the best results for the patient.
Final Thoughts: Talk To an Expert
RIRS may be the most modern surgical procedure to address all forms of kidney stones, but like any other technique, it has its caveats. The choice of RIRS has to consider stone volume, position, patient condition, and how much price one is willing to pay. An experienced urologist is best placed to advise on the suitability of RIRS for individual patients.
Dr. Deepanshu Gupta is a Urologist with experience in treating kidney stones with RIRS. He possesses vast experience in urological surgeries and offers individualized treatment options that best suit the patient’s medical condition. If you are dealing with issues related to kidney stones, Dr. Deepanshu Gupta will help figure the expert-targeted treatments that lead to a quick recovery. Schedule a demo right away!