Ureteroscopy for Kidney Stones
Ureteroscopy is a minimally invasive means of assessing the ureter, the tube that transports urine from the kidney down to the bladder. It is commonly performed for evaluation of kidney stones or blood in the urine of unknown origin, and for treating urinary tract cancers and narrowings of the ureter.
Before ureteroscopy, this kind of examination had to be done with open surgery. Today, however, a urologist can look in the ureter with a small scope about the size of a cocktail straw.
Each ureteroscope has a light and a camera, as well as a port through which a urologist can place a laser fiber, a stone basket, biopsy forceps or water irrigation.
During a ureteroscopy
- A ureterscopy takes place in a operating room, where the patient receives either spinal or general anesthesia. For eight hours prior to the procedure, the patient should not eat or drink anything except your medications with a small sip of water. In addition, he or she should not take aspirin, Ibuprofen, Advil or similar medications for a week prior to the procedure.
- After intravenous antibiotics are administered, the ureteroscope is inserted through the urethra into the bladder and then through the ureteral orifice and up into the ureter. Once in the ureter, the urologist can break up and remove a kidney stone, take a biopsy, vaporize a cancerous growth, or dilate the narrow ureter.
- Depending on the nature of the procedure and the size of the stone, the operation can take from 30 minutes to two or more hours. Typically it lasts around an hour.
- After the procedure, the urologist sometimes leaves a stent, a small rubber tube that lies in the ureter between the kidney and the bladder. A stent here allows the flow of urine between the kidney and the bladder and facilitates the passage of stone fragments into the bladder. The stent is removed at a later date, usually less than a week and is contained entirely within the body and should not interfere with urination.
- Complications of ureteroscopy may include failure to remove the stone or cancer, perforation of the ureter, injury to other structures including the urethra, bladder, ureter or kidney. In very rare cases, injury may require immediate repair in the operating room with open surgery. Infections of the urine, blood or kidney may occur. Occasionally a scar or stricture may occur weeks or months following a significant perforation, with repair required in a small percentage of cases. The urine is usually bloody for one to two days after the procedure. In rare instances patients complain of discomfort or nerve damage from positioning during surgery.
After the procedure
- Following a ureteroscopy, the patient is in the recovery room for about an hour.
- Discomfort is usually minimal. In fact, most kidney-stone patients find relief afterward, having less discomfort than before the procedure.
- If the urologist has inserted a stent, there may be a small nylon thread protruding from the urethra, connected to the stent in the ureter. The thread is used to pull the stent out later in the urologist's office. The patient should be able to urinate and stay dry despite the presence of the thread and should not pull the string.
- There will likely be blood in the urine for several days, as well as the possibility of some burning or soreness in the urethra and in the kidney. In addition, stents may cause a sensation of a full bladder or having to urinate all the time.
- Some patients with stents feel discomfort in the kidney at the time of urination due to back pressure to the kidney from the pressure generated in the bladder during urination.
- Most patients are able to return to their regular activities within a day or two.
- Stent removal is a simple procedure done with local anesthesia in the office.