RIRS is performed to remove stones without making any incisions on the kidney while using a laser and a viewing tube called a fiberoptic endoscope that goes through the urethra into the kidney. It is performed under general, local or spinal anesthesia. This procedure requires a specialized urologist who is specifically trained in RIRS.

To perform this procedure, the scope is placed through the urethra, into the ureter and finally into the urine-collecting part of the kidney. The scope is therefore moved retrograde, i.e. up the urinary tract system to within the kidney, i.e. intrarenal. Once the scope is in place, the doctor can see the stone and can proceed to manipulate or crush it by an ultrasound probe or be evaporated by a laser probe or even grabbed by small forceps.