Ureteroscopy

Ureteroscopy

Ureteroscopy involves the insertion of a ureteroscope, a tiny scope (around the width of a pen) that is placed into the urethra and moved up the urinary tract to view and/or manage challenges with the ureters. 

Types of Ureteroscopy

Rigid Ureteroscopy

• Has a straight inflexible scope.
• Optimal with stones in the lower ureter.

Flexible Ureteroscopy

• Uses a bendable scope.
• Are able to access the upper ureter and kidney stones.
• Enables laser therapy of stones or tumours biopsy.

Indications

Ureteroscopy is normally done when there is:

• Stones in the ureter or kidney 
• Ureteral strictures (narrowing)
• Blood in urine
• Ureteral tumors
• Removal of foreign bodies

Benefits of Ureteroscopy

• Minimally invasive
• Is capable of treating stone anywhere in the ureter and kidney.
• Short recovery time
• Avoids open surgery

Ureteroscopy procedure

The ureteroscopy is a sequential process that involves the following:

Before the procedure

• Medical evaluation: Blood tests, imaging and urine analysis.
• Fasting: Normally, six to eight hours before the surgery. Antibiotics: This can be administered to avoid infection.
• Anaesthesia: Since it is general or spinal anaesthesia.

Positioning

• The patient was lying in the supine position (back) on the bed. 
• Urinary area is sterilized.

Insertion of the Scope

• The cystoscope is passed in through the urethra into the bladder.
• An ureteroscope (flexible or rigid) is then inserted via the bladder into the ureter.

Visualization and Diagnosis

The surgeon examines the ureter and occasionally the kidney with the aim of determining:

• Stones
• Strictures
• Tumors
• Other abnormalities

Stone Management (in case of presence of stones)

• Stone: Removal of small stones: These can be removed with the help of a basket.
• Laser lithotripsy: The stones are larger and broken with the help of the Holmium laser, then the fragments are taken away.
• Stone retrieval: Sometimes fragments are forced to the surface using special baskets.

Stent Placement (if needed)

A DJ(DJ) stent can be temporary implanted to:

• Ensure urine flow
• Prevent ureter blockage
• Promote healing

Completion

• The ureteroscope is gradually removed.
• Monitoring of the patient is done when anaesthesia is used to wear off.

Recovery

Hospitalization:

• Inpatient: Frequently day in or day out.
• Pain: Mild pain in the flank, or burning on urination.
• Urination: Can be frequent, or burning during a number of days.
• Stent removal: 1-2 weeks (typically) in place.
• Follow-up imaging: Assures of total stone clearance.

Duration

• The procedure lasts between 30-90 minutes depending on the size of the stone, location and difficulty of the stone.

Ureteroscopy kidney stones

A ureteroscopy is a surgery that involves using a thin tube with a light and camera at the end inserted through the urethra and bladder into the ureter to find and remove or break up kidney stones located in the ureter or kidney when ESWL is likely strong. 

Indications

The kidney stones that are typically advised to have ureteroscopy are:

• Size: 5 mm - 20 mm (depending on site)
• Location: Middle or lower ureter, or in the kidney (pelvis or calices)

Other considerations: 

• Obstructing stones or infecting.
• Non-responders to ESWL.
• Patients that is anatomically or medically unable to receive ESWL.

Flexible ureteroscopy

Flexible ureteroscopy is a type of endoscopy and is performed using a small flexible tube with a camera with which the urologist is able to access the ureter and kidney for diagnosis and treatment. The flexible ureteroscope, can be advanced through the curves of the ureter and into the renal calyces and is also used for stones in the upper ureter and kidney unlike the rigid ureteroscope. 

Indications

• Kidney stones 
• Ureteral stones
• Ureteral strictures.
• Ureteral or Renal Tumor Biopsy.
• Dysuria (hematuria of unknown etiology). 

Benefits Compared to Rigid Ureteroscopy

• Able to access stones or lesions in the whole urinary tract, upper ureter and kidney.
• Less trauma to the ureter
• Frequently does not necessitate percutaneous procedures (such as PCNL).
• Has the ability to treat more than one stone in the various kidney calyces in a given session.

Ureteroscopy recovery

• This is a comprehensive review of the post recovery:
• After you have completed the procedure you should immediately stay seated or lie case to recover from anaesthesia. 
• Pain at the groin or flank and burning during urination are likely.
• The hydration is promoted to clear the stone fragments left behind.

Hospital Stay

• Outpatient practice: A majority of the patients are released on the same day.
• Overnight stay: Only in some cases when there is some complication or extensive stone removal.

Pain and Discomfort

• Carrying 1-3 days of mild pain in the flank or lower abdomen.
• The irritation of the scope may result in burning or frequent urination.
• The pain is generally treatable by the use of over-the-counter analgesics or prescription drugs.

Activity and Diet

• Rest: Within a few days, light activities can be started.
• Heavy lifting or weighty exercise: Do not do at all during at least 1–2 weeks.
• Diet: Normal diet; take ample amount of water to avoid forming new stones.

Follow-Up

• Imaging: Ultrasound or x-ray to ascertain that all the stones are removed.
• Check-up: Typically 1-2 weeks after the procedure.
• Stent removal: In case of placement, it is performed in the clinic, usually without anaesthesia.

Best hospital for ureteroscopy India

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

Conclusion

Ureteroscopy is a minimally invasive and safe procedure that is employed in diagnosis and treatment of diseases of the ureter and kidney mostly, kidney and ureteral stones. Elastic and immobile scopes can be visualized directly, rock can be removed, fragments of the laser can be removed, and lesions can be biopsied. There is an average of fast recovery where most patients would resume normal operation within few days. DJ stents can be used in the meantime in order to make sure of proper urine flow and healing. The complications are few and could be infection, damage to the ureter, bleeding, or discomfort with the stent. Altogether, ureteroscopy is a very efficient method of attaining stone clearance and treatment of Ureteral or renal anomalies with minimum downtime and high patient satisfaction.

Ureteroscopy surgery India GetWellGo

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FAQ

What is the process of doing it?

• The scope is inserted via the urethra to the bladder, and through ureter.
• Laser or basket device is used to break stones in pieces.
• Temporary insertion of a DJ stent can be done to guarantee urine flow.

Do we need anaesthesia?

• Yes. Most of the times, ureteroscopy is conducted under general or spinal anaesthesia.

What's the duration of the procedure ureteroscopy? 

• Usually 30-90 minutes, which depend on the size of stones and the site.

What is a DJ stent and its usage?

• A DJ stent is used to hold the ureter open following the removal of the stones.
• It is most commonly removed one to two weeks after the procedure.
• May result in urinary frequency, urgency or slight discomfort