RIRS surgery is recommended in patients with the following conditions:

• Kidney stones greater than 12 mm in size
• Obesity
• Stricture in kidneys (narrowing of the ureters, which are the tubes connecting the kidneys to the bladder)
• Bleeding disorders
• Failure to remove the kidney stones using other treatment methods
• Anatomically complex kidneys
• Kidney stones in children

1. Physical examination: The doctor will evaluate the physical health, medical history, and symptoms of the patient.
2. Imaging tests: Imaging tests like x-rays, MRI scans, and abdominal ultrasounds help the doctor in obtaining a clear picture of the internal organs and determine the exact stone location.
3. Blood tests: These tests help in checking if there is a presence of any underlying medical condition and also check the levels of various blood parameters.
4. Blood urea nitrogen (BUN) test: This test helps in evaluating how well the kidneys are working.
5. Urinalysis: This test helps in checking for the presence of any stones and the composition of the stones that may be present.

• The procedure may be performed under general anesthesia (the patient is put to sleep during the procedure) or spinal anesthesia (the area below the waist is numbed).
• A long, flexible tube, known as an endoscope, is inserted into the urethral passage (from where urine is eliminated from the body) to the ureter to reach the urine-collecting portion of the kidneys.
• X-rays and other imaging tests are simultaneously performed to obtain clear images of the kidneys on a monitor.
• The endoscope will be moved up in retrograde towards the kidneys.
• Once the precise location of the stones is obtained, the surgeon uses a laser probe to either crush or manipulate the kidney stones.
• A holmium laser is generally used to target stubborn stones and break them without causing any damage to the surrounding organs.
• The stones are then removed in their intact form using small forceps.
• The stone fragments are collected or caught in a stone basket. Once all the stone fragments are collected, the stone basket is removed.
• Double J stents (flexible, hollow tubes that run from the kidney to the ureter) may be then inserted to expand the passage of the ureter and help in flushing out the stone fragments from the body smoothly.
• The stone is usually kept in the kidney till the stones are flushed out of the body completely. This usually takes about 10 to 14 days.
• The procedure takes 1 to 1 and a 1/2 hours to complete.

The complications associated with RIRS surgery are as follows:

• Flank pain
• Fever
• Urine infection
• Bleeding
• Sepsis (a life-threatening infection)
• Ureter avulsion (discontinuation of the full thickness of the ureter)
• Urinary retention
• Fornix rupture 
• Transient hematuria (blood in urine)
• Kidney injury
• Death

• The patient is usually discharged from the hospital the next day after the procedure.
• A catheter is left in the urethra for eight to twenty-four hours after the surgery to relieve pain and any difficulty that the patient may be having in urinating.
• The patient needs to rest for at least twenty-four hours before being discharged.
• Recovery following a RIRS procedure takes one day. 
• The patient can resume work within two to three days of the surgery. 

Home remedies:

The following home remedies help in quicker recovery after a RIRS procedure:

1. Drink large amounts of water throughout the day to avoid any infections and maintain urine output.
2. Avoid food that is high in animal proteins.
3. Avoid spicy foodstuff for at least two months after the procedure.
4. Do not perform strenuous activities like heavy lifting during the recovery period.
5. Avoid outdoor sports and too much exercise if stents are placed inside your body. 
6. Mild physical activities that do not strain the lower body are encouraged.

Cost  of RIRS Surgery in India- 

The cost of RIRS surgery in Mumbai is between INR 90,000 to INR 1,25,000.
The cost of RIRS surgery in Delhi is between INR 80,000 to INR 1,10,000.
The cost of RIRS surgery in Bangalore is between INR 80,000 to INR 1,10,000.
The cost of RIRS surgery in Chennai is between INR 70,000 to INR 1,05,000.