Retrograde Intrarenal Surgery (RIRS) is the modern gold standard for kidney stones up to 2 cm. A thin flexible scope is passed through the natural urinary tract, and a Holmium or Thulium Fiber laser fragments the stone — no external incision, no stitches, often same-day discharge.
Dr. Deepesh Kalra has performed hundreds of RIRS procedures with the same flexible ureteroscope and laser systems used at top metro hospitals.
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RIRS — Retrograde Intrarenal Surgery — is a minimally invasive procedure for removing kidney stones using a flexible ureteroscope and a laser. Retrograde means working backwards through the natural urinary tract: the scope goes in through the urethra, up through the bladder, and into the kidney. Intrarenal means the work is done inside the kidney itself.
Once the scope is inside the kidney, a thin laser fibre is passed through it. The laser — either Holmium or Thulium Fiber — emits energy in microsecond pulses that fragment the stone into tiny pieces or sand-like dust. Larger fragments are extracted with a basket; smaller fragments and dust pass naturally over the following days.
The entire procedure is done under general or spinal anaesthesia, typically takes 45–90 minutes, and involves no external incision. A DJ stent is usually placed at the end and removed at a brief outpatient procedure 2–4 weeks later.
RIRS is the default modern treatment for kidney stones from about 6 mm to 20 mm. Stones smaller than 6 mm usually pass on their own or with medical management.
Stones in the lower pole of the kidney are challenging because of the steep angle of the calyx. Flexible RIRS can navigate this anatomy where rigid scopes can't.
Calcium oxalate monohydrate and brushite stones don't respond well to ESWL. RIRS with laser cuts through them directly.
RIRS carries the lowest risk to kidney function — preferred when you can't afford a complication.
RIRS clears residual fragments that ESWL left behind, often in a single session.
RIRS can often be done on patients who can't safely stop blood thinners — unlike PCNL which usually requires stopping them.
General or spinal anaesthesia. You are positioned for safe scope access.
Flexible ureteroscope passed gently through urethra, bladder, ureter, into kidney.
Holmium or Thulium Fiber laser fragments the stone into tiny pieces or dust.
Larger fragments removed with a basket. Dust passes naturally.
Soft stent placed to keep ureter open while it heals.
Hundreds of RIRS procedures personally performed. Experience determines clearance rates and complication rates.
Thulium Fiber Laser alongside Holmium — faster fragmentation, less heat damage, better dusting for harder stones.
We use the right scope (Olympus, Storz) and basket (zero-tip, helical) for your stone — not a one-size-fits-all kit.
Most RIRS patients go home the same day. Faster recovery, lower hospital costs.
| Procedure | Starting from |
|---|---|
| Consultation | ₹ [____] |
| NCCT KUB (if needed) | ₹ [____] |
| RIRS (one kidney, single stone) | from ₹ [____] |
| RIRS (bilateral or multiple) | from ₹ [____] |
| DJ stent removal (outpatient) | from ₹ [____] |
| Stone chemical analysis | Included |
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My stone was 17 mm in the lower pole — the toughest place. I thought I'd need a back cut. Dr. Kalra did it through the natural route with RIRS. I went home the same day.
RIRS is reliable for stones up to about 2 cm. Above that, mini-PCNL or PCNL becomes the better choice — but RIRS may still be used as a complementary procedure.
No. RIRS uses the natural urinary tract. There are no external incisions, stitches, or visible scars.
Done under general or spinal anaesthesia, so no pain during the procedure. Mild discomfort and stent-related bladder irritability for a few days afterwards is common.
45–90 minutes depending on stone size, location, and complexity. Bilateral or multiple stones take longer.
The ureter swells from instrumentation and stone trauma. A DJ stent keeps it open during healing. Removed at 2–4 weeks.
For stones under 1 cm: roughly 95–99% clearance in a single setting. For stones 1–2 cm: 80–90%. Larger stones may need a planned second sitting.
Thulium Fiber is newer and offers faster dusting with less heat damage. Holmium is still excellent for fragmentation. We use both depending on stone type.
Most patients return to desk work in 3–5 days. Gym, heavy lifting, and travel resumed at 2 weeks. Stent removal at 2–4 weeks.
Yes — RIRS is covered by all major Indian health insurers with cashless TPA partners.