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Retrograde intrarenal surgery (RIRS)
Retrograde intrarenal surgery (RIRS) is a way to remove kidney stones with no cuts in the skin. A urologist passes a thin, flexible scope through your natural urinary tract into the kidney, where a laser breaks the stone into fragments that are removed or pass in your urine, and most people go home the same day.
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Briefly about this treatment
Indications
Kidney stones causing pain, blockage, repeated infections or blood in the urine; stones too large to pass on their own or that have not moved after a period of watching and waiting; stones that shock wave lithotripsy did not clear or is unlikely to clear; and situations where an incision-free approach is preferred — for example, bleeding disorders, blood-thinning medicine, obesity or pregnancy.
Risks
Bleeding, infection and injury to the ureter, including rare narrowing (stricture) over time. Risks are minimised by careful patient selection and experienced teams.
Pre-procedure
A urine test to rule out infection, imaging (usually a low-dose CT scan) to map the stone, standard blood work, an anaesthesia consultation, and fasting per protocol.
Follow-up
A stent-removal visit within days to about two weeks, a follow-up scan a few weeks later to confirm the kidney is stone-free, and long-term monitoring for stone recurrence and kidney function.
What is Retrograde intrarenal surgery (RIRS)? An expert explains
Retrograde means travelling backwards along the path urine normally takes. During RIRS, the surgeon goes in through the urethra, up through the bladder and ureter, and into the kidney itself. The flexible scope used is thinner than a pencil and bends, so it can reach almost every corner of the kidney. Once the stone is in view on screen, a laser fibre is passed through the scope and turns the stone into fine dust or small pieces, with larger fragments lifted out using a tiny basket. Because the procedure uses the body’s own natural openings, there is no incision — and most patients are back home the same evening.
Signs it may be time for Retrograde intrarenal surgery (RIRS)
RIRS isn’t something you choose from symptoms alone — your urologist suggests it after scans show the size, place and type of your stone. Still, certain symptoms are often what send people for a scan in the first place:
- Pain in the side or back that comes in waves, sometimes spreading to the groin.
- Pink, red or brown urine.
- Burning, stinging or a sudden urge to urinate more often than usual.
- Repeated urinary infections that keep coming back.
- A stone found by chance on a scan done for another reason, even without pain.
These are the conditions linked to retrograde intrarenal surgery (RIRS) in the directory. Your clinician decides whether RIRS is appropriate using your symptoms, examination and test results.
- Nephrolithiasis (Kidney Stones) — Hard mineral deposits in the kidney that cause pain, blockage or infection.
- Urolithiasis — Stones found anywhere along the urinary tract, including the kidney and ureter.
- Recurrent Kidney Stones — Frequent stone formation that can gradually damage the kidneys over time.
- Cystine Stones — A genetic disorder that produces hard, often recurring cystine crystal stones well suited to scope-based removal.
- Horseshoe Kidney — A congenital fusion of the kidneys that can make some stone surgeries harder, which is why a no-cut approach like RIRS is often preferred.
Remember: These entries are not a diagnosis or a treatment recommendation. Discuss your symptoms and test results with a qualified clinician.
Remember: These entries are not a diagnosis or a treatment recommendation. Discuss your symptoms and test results with a qualified clinician.
When to consult a specialist
If you’re noticing any of the symptoms above, there’s no need to work out on your own whether surgery is the right step. A simple blood and urine test, together with an imaging scan, usually gives your care team everything they need to start narrowing down the options — and many people with kidney stones do well with monitoring, medication or a less invasive approach, with RIRS being just one of several paths available. The clearest way to find out what fits your situation is to talk it through with a specialist — use „Find a specialist” to book a urology consultation and get a clear next step.
How a session works
- Anaesthesia. You receive a general anaesthetic, sometimes a spinal. Antibiotics are given at the start to lower infection risk.
- Looking into the bladder. A thin camera (cystoscope) goes through the urethra into the bladder, and a soft guidewire is passed up the ureter to the kidney as a safe track.
- Access sheath (often). A thin hollow tube may be slid up the ureter, letting the scope move in and out easily and keeping pressure inside the kidney low.
- Flexible scope into the kidney. The flexible ureteroscope travels up to the kidney, with sterile fluid flowing through it so the surgeon can see clearly on a screen.
- Laser treatment. A laser fibre (holmium or thulium) passes through the scope and turns the stone into fine dust or small pieces.
- Removing fragments. Pieces are lifted out with a tiny basket or suction; some are sent to a lab to find out what the stone is made of.
- Final check and stent. The surgeon checks the kidney and ureter for leftover pieces or injury, then often places a temporary ureteral stent.
Session duration
30 minutes to 2 hours
recorded for this treatment
Cost verify
$1500–$20000
indicative range
Anesthesia
General
recorded for this treatment
Remember: The exact steps, duration and preparation can vary with your indication, health and care setting. Confirm the current plan with your treating team.
Benefits
RIRS offers a scope-based route to a stone-free kidney without any cuts, which is part of why it has become a first-line option for stones under 2 cm:
- No incision, no scar — the scope uses your natural urinary tract.
- Usually home the same day, with most normal activities back within a few days.
- High stone-free rates for stones under 2 cm, often higher than shock wave treatment in trials.
- Reaches difficult places, including the lower part of the kidney and stones that shock waves failed to break.
- A safer option when other treatments carry more risk — for example, for people on blood thinners, with obesity, or during pregnancy.
- Stone analysis — fragments can be collected and tested, which guides future prevention.
Risks & side effects
The treatment has risks and trade-offs to discuss with your care team. The information below comes from this treatment’s data: bleeding, infection and ureteral injury (including rare narrowing/stricture) are the main concerns, and risks are minimised by careful patient selection and experienced teams. Day-to-day, most side effects are mild and short-lived:
- Blood in your urine for a few days, and on and off while a stent is in place.
- Burning or stinging when you pass urine.
- Stent symptoms — needing to pee often or urgently, bladder or side pain, and tiredness, usually settling once the stent is removed.
- Passing small fragments, which can cause brief cramping and may take 8 weeks or more to clear fully.
- Anaesthesia effects such as a sore throat, sleepiness or nausea for a day.
Who it may not suit: RIRS may be less suitable if you have an active, untreated urine infection, a very large or complex stone burden better served by keyhole surgery (PCNL), or anatomy that a scope cannot safely reach. These are general cautions, not a personal verdict. A qualified clinician must assess your full medical picture before recommending or delaying treatment.
What happens during & after
During: you feel nothing because you are asleep. Low-dose X-ray and camera images guide each step, and the team keeps the fluid pressure inside your kidney low, because high pressure can push bacteria into the blood.
Straight after: you wake in the recovery room and are watched for 1–2 hours. You’ll be offered drinks and helped to walk, and most people go home once they can pass urine and pain is controlled.
The first days: expect some pink urine, burning when you pee, and needing to go often, especially with a stent in place. Your team will tell you when and how the stent comes out — with a string you (or a nurse) pull, or with a quick camera check in clinic.
Follow-up: a scan a few weeks later checks that you are stone-free. Your urologist also reviews the stone analysis and may refer you for metabolic tests or to a renal dietitian to lower your risk of new stones.
Possible complications
Serious problems are uncommon, but it’s worth knowing what your team is watching for:
- Urinary infection and fever — one of the more common problems; antibiotics given before surgery lower this risk.
- Sepsis (infection spreading to the blood) — uncommon but serious, and needs urgent hospital treatment.
- Leftover fragments that need a second procedure, more likely with large or multiple stones.
- Injury to the ureter, from a small scratch to (rarely) a tear, usually healing with a stent left in for a few weeks.
- Narrowing (stricture) of the ureter later on, from scarring — rare, but can block urine flow and may need further treatment.
- Heavy bleeding or clots, more likely in people on blood thinners.
- Not being able to pass urine, which may need a temporary catheter.
- A stent moving or falling out before planned, or a failed first attempt at access, meaning a stent is placed and RIRS is repeated in 1–2 weeks.
Your own risk depends on your stone, your anatomy and your general health — ask your urologist to go through it with you.
Remember:
New or severe symptoms require prompt medical advice. Do not wait for a routine appointment if you feel seriously unwell.
Recovery
Most people go home the same day and are back to light activity within 2–3 days. If you have a stent, you may feel uncomfortable until it comes out — usually within a few days to about 2 weeks — and full recovery normally follows a few days after that.
- Day of surgery: drowsy, pink urine, burning when peeing — rest, sip water, take painkillers as prescribed.
- Days 1–3: stent discomfort, needing to pee often, side or bladder ache — walking, fluids and bladder-relaxing medicine (if prescribed) help.
- Days 3–14: light work and daily activities resume; blood in urine comes and goes.
- Stent removal: brief cramps or spasms for 1–2 days afterwards are normal.
- Weeks 4–8: last small fragments pass, and a follow-up scan confirms you’re stone-free.
Call your urology team if pain isn’t controlled by painkillers, burning gets worse after a few days, or your stent falls out. Go to the emergency department if you have a fever above 38°C (101°F) with shivering, bright red urine or clots, uncontrolled vomiting, severe spasms, or you cannot pass urine for 6 hours. RIRS clears the stones you have now, but stones often recur — drinking enough to keep urine pale, eating to your stone type, and tracking your results in the KidneyGlobal app all help lower the risk of new ones.
Clinics offering Retrograde intrarenal surgery (RIRS)
Verified kidney centres linked to this treatment in the KidneyGlobal directory.
Academic Medical Center
Minimally Invasive Urologic Surgery
Joint CommissionNCI Cancer CenterRobotic Surgery Excellence
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Specialty Hospital
Comprehensive Kidney & Urologic Care
Joint CommissionU.S. News Best HospitalCenter of Excellence
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Johns Hopkins Brady Urological Institute
✓ AccreditedAcademic Medical Center
Urologic Oncology & Innovation
Joint CommissionNCI Comprehensive Cancer CenterResearch Excellence
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Good questions
Most Common Questions
Is RIRS the same as ureteroscopy?
RIRS is a type of ureteroscopy. The name RIRS is used when a flexible scope goes all the way up into the kidney; ureteroscopy is the broader term, which also covers treating stones lower down in the ureter.
Is RIRS major surgery?
No. It's a minimally invasive procedure with no cuts, usually done as day surgery. You still have a general anaesthetic, so you'll need someone to take you home.
How long does it take to recover from RIRS?
Most people return to light activities within 2–3 days. With a stent in place, full comfort usually returns a few days after it's removed.
Will my stones come back after RIRS?
RIRS removes the stones you have now, but it doesn't stop new ones from forming. Stone analysis, blood and urine tests, and diet changes all help lower your risk of recurrence.
How much does RIRS cost?
Costs vary widely by country, hospital, stone size and insurance coverage — broadly from the low hundreds to around $20,000 USD equivalent. Contact the clinic directly, or check the listing, for current price information.
Can I have RIRS if I take blood thinners?
Often yes — RIRS is one of the preferred options for people who can't safely stop blood thinners. Never stop any medicine without talking to your doctor first.
Sources
- EAU Guidelines on UrolithiasisEuropean Association of Urology
- EAU Guidelines on Urolithiasis 2025 — full text PDFEuropean Association of Urology
- EAU Guidelines on the Diagnosis and Treatment of UrolithiasisEuropean Urology
- Surgical Management of Kidney and Ureteral Stones: AUA GuidelineAmerican Urological Association
- Surgical Management of Kidney and Ureteral Stones: AUA Guideline (2026) Part IJournal of Urology