Complete Kidney Stone Management with RIRS & PCNL Surgery

Who needs RIRS or PCNL?

Many small kidney stones pass on their own with fluids and medicines. Surgery is advised when a stone is unlikely to pass or is already causing harm. Common reasons include:

• Stones larger than about 6–7 mm, or stones that have not moved after a few weeks
• Repeated attacks of severe pain (renal colic) that need emergency visits
• A stone blocking urine flow and causing swelling of the kidney (hydronephrosis)
• Fever or infection along with a stone, which needs urgent drainage
• Stones in a single kidney, or reduced kidney function
• Large, branched (staghorn) stones that will not pass naturally

RIRS vs PCNL: how Dr. Bivek Kumar chooses

RIRS (Retrograde Intrarenal Surgery) uses a thin, flexible ureteroscope passed through the natural urinary passage into the kidney. A holmium or thulium fibre laser breaks the stone into dust or small fragments. There is no cut on the skin. RIRS usually suits kidney stones up to about 2 cm, stones in difficult corners of the kidney, and patients on blood thinners or with other medical conditions.

PCNL (Percutaneous Nephrolithotomy) reaches the kidney through a small keyhole in the back. It is the most effective option for stones larger than about 2 cm and for staghorn stones, because large stone volume can be cleared in a single sitting. Mini-PCNL and ultra-mini PCNL use even smaller tracts, which means less bleeding and quicker recovery.

The right choice depends on stone size, hardness (measured on CT scan), position, kidney anatomy and your overall health. Dr. Bivek Kumar reviews your CT scan with you and explains why one approach is preferred, so the decision is shared and clear.

Before the procedure

• A non-contrast CT KUB scan to map the stone exactly
• Urine culture to make sure there is no active infection
• Routine blood tests and an anaesthesia check
• Advice on stopping or adjusting blood thinners, if you take them

Recovery after RIRS and PCNL

Most RIRS patients go home the same day or the next day. A temporary DJ stent is often placed to keep urine draining smoothly and is removed in one to three weeks in a short OPD procedure. After PCNL, a hospital stay of one to three days is typical. Most people return to desk work within a week. Mild burning while passing urine or a little blood in the urine for a few days is common and settles on its own.

Possible risks

Both procedures are safe in experienced hands, but no surgery is risk-free. Possible issues include infection, bleeding (more relevant with PCNL), stent discomfort, and small leftover fragments that may need follow-up. Careful planning and a sterile urine before surgery keep these risks low.

Preventing stones from coming back

Up to half of people who form a kidney stone will form another within ten years. After your stone is removed, the fragment can be sent for stone analysis. Based on that, Dr. Bivek Kumar advises on fluids (aim for 2.5–3 litres of urine a day), salt and protein intake, and, where needed, a 24-hour urine study and medicines to lower your risk.

Kidney stone treatment in Koramangala and Bellandur

Dr. Bivek Kumar performs RIRS, mini-PCNL and PCNL at Superhealth Hospital, Koramangala (OPD Monday to Saturday, 9 am to 6 pm) and Nelivigi Multispeciality Hospital, Bellandur (OPD Tuesday, Thursday and Saturday, 7 pm to 8 pm; Sunday by appointment only). Consultations are available in English, Hindi, Kannada and Bengali.

More questions patients ask

What size of kidney stone needs surgery?

Stones under about 5 mm often pass naturally. Stones over 7–10 mm, or any stone causing blockage, infection or repeated pain, usually need treatment such as RIRS, URS or PCNL.

How long does RIRS take?

RIRS usually takes 45 to 90 minutes, depending on stone size and hardness.

Is a stent always needed after RIRS?

Not always, but a DJ stent is commonly placed for one to three weeks to protect the kidney and help fragments pass.

When can I return to work after PCNL?

Most people return to desk work in about a week and to heavier physical work in two to three weeks.