Ureteroscopy and lasering of stone

What is Ureteroscopy?

Ureteroscopy is an operation where a telescope is passed up into the ureter or tube that runs from the kidney to the bladder.  This is usually performed to treat kidney stones either in the kidney itself or stuck in the ureter. When removing stones a laser is usually used to break the stone up into little pieces.


CT reconstruction of ureters with a schematic picture of structures

Ureteroscopy is done under a general or spinal anaesthetic. The instrument or ureteroscope is a very thin telescope and can be semi-rigid or flexible. Semi-rigid ureteroscopes are used to treat stones in the lower ½ of the ureter while flexible ureteroscopes are used for the upper ½ of the ureter and for looking into the kidney.

Why do I need an Ureteroscopy?

Ureteroscopy is usually used to remove stones that are causing pain. It can also be used to treat small cancers in the lining of the kidney or for looking into the inside of the kidney if there are cancer cells found in the urine.

What do I need to do before my operation?

  • As you will be having an operation you need to have no food for 6 hours prior to the operation time, and clear fluids (no milk or orange juice) up to 3 hours before surgery.
  • You may need to have an x-ray the day of or day before to check where the stone is.
  • You should stay on your normal medications but please let me know if you are on warfarin, dabigatran, or clopidagril
  • Stop all herbal medicines or supplements 1 week prior to surgery.

What does the operation involve?

The operation is performed under a general anaesthetic, so you are asleep. Once asleep you will be positioned so that a telescope can be passed through the urethra up into the ureter. (The urethra is the tube that you pee through).

A telescope is placed into the bladder through the urethra. A wire is then passed up into the kidney under x-ray control. The ureteroscope is then passed alongside the wire until the stone is seen.

Once the stone is seen a laser fibre is passed up inside the telescope and under direct vision the stone is lasered into little fragments. These are then pulled out with a basket.


Stone captured in a basket and then being lasered.

If the stone(s) are in the kidney then an access sheath is placed into the ureter to allow the flexible ureteroscope to pass up into the kidney easily. Once in the kidney the kidney is carefully inspected until the stone is found. It is then either lasered or basketed as needed and removed.

 


Flexible ureteroscope passed into the ureter and stone basketed

What happens afterwards?

If a rigid ureteroscopy has been performed then it is likely you will go home on the same day as your operation. If a flexible ureteroscopy was done then you will probably stay the night. A drainage tube or a stent maybe left in after the surgery especially if an access sheath was used. . This is to allow the kidney to drain and any swelling to settle down. If it is a drainage tube then this will be removed the next day. If a stent has been placed then this will usually stay in for a week or two.



What can go wrong?

The commonest problems are

  1. Pain after the operation
  2. Cant get to the stone
  3. Urinary tract infections afterwards

Pain is common after the operation. This is caused by spasm of the ureter. You will be given pain relief after surgery. Placing a drainage tune after surgery usually reduces the severity and frequency of pain.

Sometimes it is not possible to reach the stone with the telescope. If this happens then a stent will be placed to allow the kidney to drain and to encourage the ureter to stretch up or dilate. This makes it easier to reach the stone the next time.

Sometimes the stone will roll up into the kidney and can't be found. In this case a stent will also be placed and the operation repeated.

Urine infections (UTI) after surgery are uncommon but if you get a lot of burning and stinging pain when passing urine then you should be checked for a UTI.

Extremely rarely the ureter can be torn during the operation.  This is so rare that most surgeons never see a case in their entire working lifetime.

What other options do I have?

Alternative options to Ureteroscopy and lasering of a stone are

  • Wait for it to pass
  • ESWL (external shock wave lithotripsy)
  1. This is a shock wave passed from outside the body in.
  2. It is useful for kidney stones but not for stones in the ureter.
  • PCNL (percutaneous nephrolithotomy)

  1. This involves puncturing the kidney with a telescope. It is usually used for large kidney stones (more than 2cm across)

Useful websites

http://patients.uroweb.org/fileadmin/files/english/01_Causes_of_kidney_and_ureteral_stones_01.pdf

http://urology.ufl.edu/patient-care/stone-disease/procedures/ureteroscopy-and-laser-lithotripsy/