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Introduction
Ureteroscopy is a procedure in which a small telescope, called a ureteroscope, is inserted through the urethra, through the bladder and up into the ureter (Fig. 1 and Fig. 2). It is used to diagnose and treat a variety of problems in the urinary tract, such as ureteral or kidney stones and tumor in the ureter or kidney.
For ureteroscopic stone removal:
If the stone is small, it can be removed using a device called a stone basket (Fig.3 and Video 1). If the stone is large, it can be broken down into smaller pieces using a laser (a procedure known as laser lithotripsy) (Fig. 4 and Video 2).
[Warning: These video clips include footage from an actual procedure which some viewers may find difficult to watch.]
Ureteroscopy is usually performed under general anesthesia. It is usually done as an outpatient procedure (going home the same day). However, some patients may require an overnight hospital stay if the procedure proves difficult or lengthy.
Video 1 : Stone Basket Extraction
Video 2 : Laser Lithotripsy Stone Removal
Potential Risks and Complications:
There are risks and complications associated to intravenous sedation or general anesthesia. In addition there are potential specific risks related to ureteroscopy.
These risks may include:
Bleeding or hematuria (presence of blood in urine) (common)
Pain or burning during urination (common)
Infection (rare)
Sepsis (bacteria spreading into bloodstream) (rare)
Injury to the ureter or kidney (rare)
Urinary retention (the inability to urinate) (rare)
Additional procedure or surgery may be needed (rare)
Preparation for the Procedure:
Before the procedure your doctor will perform a history and physical exam as well as order appropriate laboratory tests to make sure you are in good condition for the procedure.
Generally, you cannot eat or drink anything, with the exception of a tiny sip of water, at least 8 hours prior to procedure.
You should also arrange for transportation to and from the surgery center or hospital.
You should let your doctor know:
If you are or may be pregnant, have any allergies to medications or food (such as seafood), or allergies to latex (rubber).
You should let your doctor know of all the medications you are taking including over the counter medications.
If you are taking blood thinners (eg. Coumadin, Plavix, aspirin, ibuprofen, etc.), ask your doctor when to stop taking these medications.
If you have diabetes you should ask your doctor if you should stop taking diabetic medications on the day of procedure. Normally, you can take other medications with a tiny sip of water.
Additional Procedures may be done with Ureteroscopy:
Sometimes your doctor may need to insert a ureteral stent after the ureteroscopy (Fig. 5).
A ureteral stent is a small, soft, flexible plastic tube that goes from the kidney through the ureter to the bladder.
The stent has a coil that is j-shaped in the kidney and another j-shaped coil in the bladder. (Sometimes the stent is also called a double-j stent.) The stent helps ensure the drainage of urine from the kidney into the bladder without obstruction from the swelling of the ureter after a ureteroscopy.
It is very important that the stent needs to be removed as instructed by your doctor.
Having the ureteral stent inside your body too long may cause stone formation, blockage of the ureter or loss of kidney function.
What to Expect after a Ureteroscopy?
Your doctor may give you pain medication and antibiotics to take after ureteroscopy.
You may expect some burning or discomfort during and after urination
You should also expect mild or moderate pain in your side or back during and/or after urination.
It is common to see some blood in the urine (pink colored).
You are encouraged to drink more water and urinate often.
If you have a ureteral stent placed you may feel the urge to urinate often and have pain in the bladder.
Try to relax during urination, do not push or strain, as pressure will build up in the bladder and be transmitted up the stent to the kidney causing more pain in the kidney.
Call your Doctor if...
There is heavy bleeding (passing blood thick like ketchup)
You are in severe pain (not controlled by pain medication)
You have severe nausea or vomiting
Go to the emergency room if...
You have fever (temperature greater than 101F)
You have shaking chills