RIRS: Kidney Stone Treatment with a Flexible Endoscope
A method in which the kidney is reached through the urinary passage, with no incision anywhere on the body, and the stone is turned to dust with a laser. Who is it suitable for, why is a JJ stent placed and what is recovery like?
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 45–90 minutes
- Anesthesia
- General anaesthesia
- Hospital stay
- Day case or 1 night
- Stay in Türkiye
- 4–6 days
- Return to work
- 3–7 days
- Flight clearance
- 2–3 days
About the condition
RIRS (retrograde intrarenal surgery) treats a kidney stone without any incision being made in the body. A slim, bendable endoscope is passed through the urinary passage into the bladder, then up the urinary tube (ureter) and finally into the kidney. The stone is seen directly and either turned to dust or broken into small pieces with laser energy.
Because the tip of the instrument bends, areas of the kidney that are hard to reach can also be accessed, particularly the region known as the lower pole. Depending on where the stone sits, this is one of the reasons the method is chosen.
When the stone is turned to dust with the laser, most of the particles pass out on their own with the urine; larger pieces can be retrieved with a special basket. Throughout the procedure a thin sheath is usually placed in the ureter to protect it and to allow the instrument to move freely.
A JJ STENT AFTERWARDS: in most patients a thin, flexible tube called a JJ stent is placed between the kidney and the bladder at the end of the procedure. Its purpose is to prevent blockage from swelling and to let the stone dust pass easily. The stent stays in for anything from a few days to a few weeks and is removed in a short outpatient procedure.
STENT SYMPTOMS ARE REAL. While the stent is in place you may have to pass urine frequently, feel discomfort at the end of passing urine, notice a sense of fullness in the flank and see slight bleeding in the urine. These usually settle quickly once the stent is removed; they do not mean the procedure has failed. Knowing about this in advance makes the period far easier to get through.
In some men whose ureter is very narrow, it may not be possible to reach the kidney at the first sitting. A JJ stent is then placed first so that the ureter can widen, and the procedure is carried out a few weeks later. This is not a complication but a planned two-stage approach.
Who is it suitable for?
May be suitable
- Patients with a moderately sized stone inside the kidney
- Stones sitting in the lower pole of the kidney that are unlikely to pass on their own
- Patients in whom shock wave lithotripsy (ESWL) has been tried without success
- Patients with a bleeding disorder or on blood thinners — the bleeding risk is lower than with the percutaneous method
- Patients who are overweight, and anatomies in which percutaneous access would be technically difficult
- Patients with a single kidney — it may be preferred as the kidney tissue is not entered
- Patients with stones in both kidneys where treating both sides in one admission is planned
May not be suitable
- Patients with a very large or staghorn stone — the percutaneous method is more appropriate
- Patients with an untreated urinary tract infection — this must be treated before the procedure
- Patients with a stricture in the ureter that does not allow passage — this is dealt with first
- Patients for whom general anaesthesia is unsuitable
- Situations where the stone is very hard and many sittings are expected to be needed — the percutaneous method may achieve the result in one
Technology used
- Flexible ureterorenoscope
- Holmium or thulium fibre laser system
- Ureteral access sheath — protects the ureter and helps keep pressure inside the kidney down
- Stone basket for retrieving fragments
- Chemical analysis of the retrieved stone and assessment aimed at preventing recurrence
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Before the procedure
Assessment
A non-contrast CT scan establishes the size, position and density of the stone. A urine culture is taken; if there is infection the procedure is postponed and the infection treated first.
- Day of the procedure
Treating the stone with the laser
Under general anaesthesia the kidney is reached through the urinary passage with no incision. The stone is seen directly and turned to dust with the laser. The procedure usually takes 45–90 minutes and a JJ stent is placed at the end.
- First 24 hours
Observation
Most patients are discharged the same day or the next. A pink tinge to the urine and a mild sense of fullness in the flank are expected.
- Weeks 1–2
Stent period
The stone dust passes during this period. Frequency and discomfort at the end of passing urine can occur; plenty of fluids are advised.
- After the stent is removed
Check-up and prevention
The stent is removed in a short outpatient procedure. Imaging confirms that the kidney is stone-free. According to the stone analysis, a diet and fluid plan is drawn up to prevent recurrence.
Method comparison
| Criterion | RIRS | PCNL |
|---|---|---|
| Skin incision | None | About 1 cm in the flank |
| Suitable stone size | Small to moderate | Large and staghorn |
| Hospital stay | Day case or 1 night | 2–3 nights |
| Bleeding risk | Lower | Higher |
| Stone-free in one sitting | High for small stones; a further sitting may be needed for large ones | A higher chance of clearing large stones in one sitting |
| JJ stent | Usually placed | A nephrostomy tube or stent may be needed |
| Return to work | 3–7 days | 1–2 weeks |
The two methods are not rivals but solutions to different situations. RIRS stands out for small and moderate stones, PCNL for stones that form a large burden. In some patients the two can be planned together.
Risks
- INFECTION AND BLOOD POISONING (urosepsis): the most serious risk; this is why a urine culture before the procedure and treatment of any infection are compulsory. Fever and shivering require immediate medical attention
- Blood in the urine — usually slight and settles on its own
- Symptoms from the JJ stent — frequency, fullness in the flank, discomfort at the end of passing urine; these go once the stent is out
- Injury to the ureter or a stricture developing later — uncommon
- Fragments of stone left behind and a second sitting being needed
- Not being able to reach the kidney at the first sitting — if the ureter is narrow, a stent may be placed and the procedure postponed
- Recurrence of the stone — stone disease can come back if preventive measures are not taken
Alternatives
- Shock wave lithotripsy (ESWL) from outside the body — for stones of suitable size and position
- PCNL (percutaneous nephrolithotomy) — for large and staghorn stones
- Mini-PCNL — for moderately sized stones, through a smaller tract
- A trial of medical expulsive therapy and surveillance — for small stones that have moved down
- Open or laparoscopic stone surgery — very rarely, in special situations
Recovery
First 48 hours
A pink tinge to the urine and mild fullness in the flank are expected. Drinking plenty of fluids helps the stone dust to pass.
Days 3–7
Daily life resumes. A return to desk work is possible during this period. Heavy lifting is avoided.
Weeks 1–2
The stent is in place and can cause symptoms. Drinking plenty of water and taking the medication your doctor advises bring relief.
Stent removal
It is removed in a short outpatient procedure. The symptoms settle quickly.
Months 1–3
Imaging confirms that the kidney is stone-free. A preventive plan based on the stone analysis is put into practice.
Frequently asked questions
Will an incision be made in my body for RIRS?
No. No incision at all is made. A slim, bendable endoscope is passed through the urinary passage into the bladder, up the urinary tube and into the kidney. No visible scar is left.
How is the stone removed?
The stone is seen directly and turned to dust with laser energy. Most of the dust passes out on its own with the urine. Larger pieces are retrieved with a special basket if necessary.
Why is a JJ stent placed and how long does it stay?
It is placed to prevent blockage from post-procedure swelling and to let the stone dust pass easily. It usually stays in for anything from a few days to a few weeks and is removed in a short outpatient procedure.
Is the stent uncomfortable?
Yes, it can be, and this is expected. Frequency, discomfort at the end of passing urine, a sense of fullness in the flank and slight bleeding in the urine may occur. These usually settle quickly once the stent is removed and do not mean the procedure has failed.
Will my stone be cleared completely in one sitting?
That depends on the size, hardness and number of stones. For small and moderate stones one sitting is usually enough. If the stone burden is heavy, a second sitting may be planned; this is discussed from the outset and is not a sign of failure.
What is the most important risk?
Infection passing into the blood (urosepsis) is the most serious risk. That is why a urine culture is taken beforehand and any infection is treated. If fever and shivering occur after the procedure, seek medical attention without delay.
Which is better, RIRS or PCNL?
There is no single "better" method; the two are solutions to different situations. For small and moderate stones RIRS stands out because it requires no incision and carries a lower bleeding risk. For large and staghorn stones PCNL is preferred because the chance of clearing them in one sitting is higher.
What happens if the kidney cannot be reached at the first sitting?
In some patients the ureter is too narrow to allow the instrument through. A JJ stent is then placed first and the ureter is allowed to widen on its own; the procedure is carried out a few weeks later. This is not a complication but a planned approach.
Will my stone come back?
Stone disease can recur if preventive measures are not taken. For this reason the retrieved stone is analysed chemically and, according to the result, a protective plan covering fluid intake, diet and, where needed, medication is drawn up.
When can I fly and return to work?
Flying is usually permitted after 2–3 days; a stay of 4–6 days is planned for patients travelling from abroad. A return to desk work is possible within 3–7 days. Removal of the stent is planned before you go home, or arranged to be done in your own country.
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This page is for general information only and is not a substitute for medical advice.
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