Flexible Ureteropyeloscopy and Lasering of Stones
Ureteroscopy is performed to inspect the ureter and interior of the kidney and to treat stones located within the ureter or kidney. Flexible scopes are used to inspect and treat stones within the upper ureter and kidney. Rigid scopes are used to treat stones within the lower ureter.
Procedure
Ureteroscopy is performed under a general anaesthetic. A long narrow telescope is inserted through the urethra, into the bladder then up into the ureter and kidney. Stones are treated by advancing a thin laser fibre through the ureteroscope and using the laser beam to fragment stones within the ureter or kidney. The larger stone fragments are then removed with a small basket.
Following stone treatment a temporary ureteric stent may be inserted. A ureteric stent is a thin flexible plastic tube running from the kidney along the ureter into the bladder. It is entirely internal. A ureteric stent may be placed for several reasons:
- The ureter may be too small to allow easy telescope passage. If this is the case then leaving a ureteric stent in for two weeks allows the ureter to dilate thus allowing ureteroscopy at a later date.
- There are residual stones in the kidney, which require further treatment. The stent allows the kidney to continue to drain easily preventing further episodes of colic and allowing easy re-introduction of the ureteroscope at a second procedure.
- The stone has been removed however there is concern that the ureter may swell following surgery. This causes pain identical to renal colic. A stent prevents this. The stent is usually removed within two weeks.
Post-Procedure
Flank pain is common immediately following ureteroscopy. This is due to swelling of the ureter and also irritation from the presence of a ureteric stent. You will notice blood in your urine which will continue for approximately one week or longer if a stent is present. Urinary frequency and urgency is normal and also may be due to the presence of a ureteric stent. You may head home later the same day if you are comfortable, otherwise an overnight stay may be recommended. If a ureteric stent has been placed then arrangements will be made to remove this in my office in two weeks time. This will be either by a brief flexible cystoscopy or by slowly pulling on a long thread attached to the lower end of the stent.
Risks
Inability to pass the ureteroscope into the ureter: usually due to a tight ureter and dealt with by placement of a temporary ureteric stent then returning for a repeat procedure in two to four weeks.
Incomplete removal of stones: large and multiple stones may require several procedures to clear all stones.
Damage to the ureter: minor damage to the ureter can occur due to trauma from telescope passage. Temporary ureteric stent placement will allow the ureter to heal.
The most significant injury is complete ureteric rupture. This is an extremely rare injury. Repair requires an open operation via an abdominal incision. Removal of the kidney may even be required.
Return to Work
Most patients can return to work within one week of surgery. If a ureteric stent is in place then this may cause flank discomfort, more frequent urgent urination and blood staining of the urine. Sedentary jobs can usually be performed with a stent in place however a more physical job may need to be avoided until the stent has been removed.
Follow-up after surgery
Once the stone has been cleared, a metabolic evaluation may be ordered to investigate for reversible causes of stone formation. The results of stone analysis will be discussed. An x-ray three months following surgery will assess for the presence of residual stone fragments.