Ureteroscopic Fragmentation of Ureteric Stone

Ureteroscopic fragmentation ureteric stone

Ureteroscopic fragmentation is a less invasive surgery that takes place to remove or fragment stones in the ureter through the use of a ureteroscope. The energy sources such as laser and pneumatic lithotripters are used to fragment the stones and then removed or allowed to naturally occur.

Indications

• Obstructive and painful ureteric stones.
• Resistant Stones which are not being treated in accordance with medical expulsive therapy.
• Stones that bring about infection or hematuria.
• Rocks in patients with solitary kidney or impaired renal ability.

Advantages

• Minimally invasive
• High stone clearance rates
• Rapid recovery
• Applicable to different sized and different location stones in the ureter.

Ureteroscopy laser lithotripsy

Minimally invasive laser lithotripsy Ureteroscopy is a procedure used to view directly through a ureteroscope a ureteric or renal stone, which is broken apart with a laser (which can most often be Holmium: YAG).

Indications

• Stones of the ureter, which are not expelled by medical treatment.
• Obstructive, painful, or infectious stones.
• Rocks within a solitary kidney or renal failure.
• Stones not fit in shockwave lithotripsy (SWL).

Procedure Steps

Preparation Before Surgery

• Fasting, and routine laboratory blood tests
• Prophylactic antibiotic, if there is risk of infection.
• Informed consent, discussion of risks including hematuria, infection, ureteral injury. 

Anaesthesia

• General or Spinal is used.

Ureteroscopic Access

• The insertion of a flexible or semi-rigid ureteroscope is through the urethra, bladder and into the ureter.
• The rock is perceived in its actual form.

Laser Lithotripsy

• It uses the holmium: YAG laser above all.
• Stone is cut into little chunks or dust “dusting technique.
• Retrieval basket can be used to extract stone fragments.

Ureteral Stenting

• In order to guarantee the drainage of urine and healing, a temporary ureteral stent can be used.

Postoperative Care

• Typically outpatient or short-term hospital care.
• It may have mild hematuria, urgent urine or abdominal pain.
• Sufficient water intake is promoted.
• Removal of stents 1-2 weeks later.

Ureteric stone fragmentation procedure

Lithotripsy is laparoscopically less invasive procedure of shattering ureteric stones in the ureter, into smaller pieces so that they may pass on their own or be removed.

Preparation before Surgery

• Fasting for 6–8 hours
• Blood tests: CBC, tests of the renal function.
• Urine culture to exclude infection.
• Prophylactic antibiotic, if there is risk of infection.
• Informed consent, discussion of risks including hematuria, infection, ureteral injury. 

Procedure Steps

Anaesthesia

• Typically general or spinal anaesthesia.

Access

• A ureteroscope (flexible or rigid) is then inserted down the urethra into the bladder followed by the ureter.

Stone Visualization

• Ureteroscopic view of the stone. 

Fragmentation

• Laser lithotripsy (Holmium:YAG laser) is the most common type;; it breaks stones into small pieces or dust
• Mechanical fragmentation (Pneumatic lithotripsy) 
• Stones could be cleared by use of a basket or could be allowed to fall naturally.

Stent Placement

• Ureteral stent can be used temporarily to enable healing and drainage.

Postoperative Care

• Typically a same-day or one-day in-patient.
• Mild pains, frequency of urination and blood in urine can also come up.
• Take lots of water to aid in flushing out fragments.
• Removal of stents 1-2 weeks later, when in place.
• Fellows imaging to follow-up stone clearance.

Ureter stone fragmentation recovery

The act of healing the body, the passage of stone fragments and restoration of normal urinary functions after ureteroscopic stone fragmentations is known as recovery.

Immediate Postoperative Period 

• There were no reports of pain, fever, or swelling after the drainage from the patient.
• Usually a day surgery or a day admission.
• Follow Up: Vital Signs, Urine Output, blood in the urine. 
• The pain in the flank is mild or urinary urgency.
• Pain control: Oral analgesics under prescription.
• Hydration: make sure there is plenty of water to assist in flushing stone fragments.

Ureteral Stent (in case of placement) Care

• It is possible to insert a stent to hold the ureter and heal.
• Stent removal: 1-2 weeks post-procedure (typically)

Activity & Lifestyle

• Do not overexert one in a few days.
• Gradually resume normal functions.
• Keep hydrated so that it is easy to pass the fragments of the stone.
• Observe urine and blood or blood fragments.

Follow-Up

• Follow-up imaging to confirm stone clearance. 
• Test on urine to confirm infection or residual fragments.
• Examination of metabolic workup in case of recurring stones.

Ureteroscopy stone complications

Ureteroscopy is a relatively safe procedure, but just as any other procedure, it has the risks and complications, both mild and severe.

• Hematuria
• Urinary Tract Infection
• Ureteral Injury or Perforation
• Ureteral Stricture
• Residual Stone Fragments
• Stent-Related Complications

Uncommon Complications

• Ureteral avulsion (very rare)
• Perirenal or retroperitoneal hematoma
• Sepsis due to infection
• Damage to adjacent organs

Best hospital for ureteroscopic stone fragmentation India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Ureteroscopy and stone fragmentation, more so with laser lithotripsy, is a safe, effective and minimally invasive intervention in the management of ureteric stones. It enables direct visualization and accurate fragmentation of stones, offers high rates of stone clearance and rapid recovery rates after cultural surgery as opposed to open surgery. The majority of patients have mild and self-limiting pain and temporary ureteral stents are used to aid in recovery. Even though complications like hematuria, infection, injury to the ureter or stone fragments could occur, generally these are managed with conservative therapy or minor interventions. Ureteroscopy is an excellent treatment option for patients with ureteric stones when appropriate care is taken during the procedure and in the pre and postoperative periods to make sure that the patient experiences minimal pain, obstruction, and risk of recurrence.

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FAQ

1. Is the procedure painful?

• This can be done anaesthetically, which is pain-free.
• The procedure may result in mild flank pain or urinary urgency particularly when a stent has been inserted.

2. Will I need a stent?

• In certain cases a temp stent is done in the ureters to assist in passing out urine and healing.
• The removal of stents normally occurs at the end of 1-2 weeks.

3. Will I become free of any stones post-procedure?

• Majority of patients becomes completely stone clear.
• There are fragments which might need secondary treatment.
• The imaging is followed up to confirm total removal of stones.

4. Does recurrence occur following the ureteroscopy?

• Stones may recur yes and mostly in cases where there are risk factors such as dehydration, diet or metabolic conditions. The recurrence can be reduced with lifestyle changes and medical recommendations.