Ureteroscopy

Overview

Ureteroscopy, commonly performed as an outpatient procedure, primarily addresses stones in the ureters or kidneys, as well as other conditions causing kidney blockage or hematuria (blood in urine).

The procedure entails employing an ureteroscope—a lengthy, slender tube featuring an eyepiece at one end and a miniature lens with a light at the opposite end.

Ureteroscopy for stones is often performed in two ways:

• Small stone: In case the stone is small, the healthcare provider will use a scope to extract it from the ureter. The particular kind of scope utilized in this process will have a little basket attached to the end of a wire that passes through an additional ureteroscope channel. The stone is collected using the basket.
• Large stone: The healthcare provider will insert a flexible fiber through the scope all the way up to the stone if it is bigger. The healthcare provider will use a laser beam passing through the scope to shatter the stone into fragments small enough to be expelled from the body through urine.

The choice of ureteroscopy treatment depends on factors such as the stone’s location, size, and composition, which are assessed by your healthcare provider to determine the most suitable approach.

Reasons for undergoing the procedure

Ureteroscopy may be advised by your healthcare provider if you exhibit symptoms like hematuria (blood in the urine) or if there are indications of ureteral or kidney blockage, possibly due to conditions such as stones or tumors. This procedure is particularly effective for ureteral stones located near the bladder, especially in the lower half of the ureter, and it remains a viable option for individuals who are pregnant, obese, or have blood clotting disorders.

Risk

The following are possible risk of ureteroscopy:

• Bleeding.
• Infection.
• Injury to the ureter.

One in a thousand people will get a serious injury that could need to be repaired by an extended operation. To help in the kidney’s healing and drainage, a healthcare provider might need to put a stent, which is a tiny tube, and leave it in place for one to two weeks. A scheduled appointment for the removal of any stents they may have will be arranged.

The patient can have some pain when they urinate afterwards. Urinating could be challenging for a while if they have swelling in their ureter.

Before the procedure

Before undergoing a ureteroscopy, it’s advisable to consult your healthcare provider regarding any specific preparation instructions. Typically, patients are advised to refrain from eating prior to the procedure. Additionally, you might be requested to provide a urine sample beforehand to screen for infections, with instructions possibly including abstaining from urination for an hour preceding the procedure.

During the procedure

During a ureteroscopy procedure, once anesthesia has taken effect, the urologist inserts the tip of a ureteroscope into the urethra, progressing it into the bladder and releasing a sterile solution to enhance visibility of the bladder walls. They then navigate the scope into a ureter, potentially extending it into the kidney if needed, a process that may take up to 30 minutes for observation alone or longer if interventions like stone removal, fragmentation with a Holmium laser, or tissue biopsy are performed. Stone removal using a laser typically extends the procedure to about 90 minutes. Another method involves employing a tiny basket attached to the scope to grasp and extract stones.

After the procedure

Following the removal of the ureteroscope and drainage of the bladder contents, the patient will gradually recover from anesthesia, which typically takes one to four hours. While stents are not commonly used, occasionally, one may be left in place for support. Over the next 24 hours, individuals may experience some discomfort and observe blood in their urine while urinating, but any discomfort should subside after this period. It’s crucial for patients to have someone available to accompany them home upon discharge.

Outcome

The majority of ureteroscopy patients have mild to moderate discomfort that is manageable with medicine. To reduce the mild pain, the following instructions include:

• For the first two hours following the surgery, they should consume two eight-ounce glasses of water every hour.
• Patient can take a warm bath to ease the discomfort with permission from the healthcare provider.
• They can cover the urethral hole with a warm, moist washcloth.
• Heating pads or ice packs used to the kidney may provide pain relief.

They might have to wait a few days for the test results if a bit of tissue was taken for a biopsy.

Bladder and kidney pains as well as burning when urinating are additional adverse effects. Patient should drink additional water if their urine appears pink or red. These signs and symptoms might continue until the stent is taken out.

In order to avoid infection, the healthcare provider could prescribe an antibiotic for the first two days following the surgery. Increased discomfort, fever, and chills are indicators of an infection. Notify the healthcare provider if the patient notice any of these symptoms.