Ureteroscopy involves the passage of a small telescope via the urethra into the ureter (the tube that drains the kidney) and kidney without the need for any incisions.
The procedure may be diagnostic (to rule-out a concerning source of blood in the urine) or therapeutic (to treat urinary tract stones or cancer). Additional tools can be passed through the telescope. Commonly during treatment for stones, a small laser fiber is passed that can fragment a stone, which can then be retrieved with a basket. Ureteroscopy usually requires placement of a temporary ureteral stent postoperatively to allow for healing of the ureter.
When to ask a Urologist about Ureteroscopy
You should speak with a Urologist about Ureteroscopy if you have kidney or ureteral stones less than 2 cm that have failed to pass spontaneously. Ureteroscopy can also be used for the diagnosis, and potential treatment of ureteral scarring, bleeding, or tumors.
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
Although the likelihood of success depends on stone volume and location, ureteroscopy is quite effective. For small to moderate kidney and ureteral stones, stone-free rates are around 90%. For total stone burden over 2 cm, ureteroscopy has lower success rates (around 75%), and PCNL is the preferred approach. Occasionally however, the ureter may be too narrow to accommodate the instruments and stones may not be accessed during an initial procedure. In this event, a ureteral stent is placed to slowly dilate the ureter with plan for repeat attempt in several weeks.
Possible Side Effects
The risks of the procedure include pain, bleeding, infection, damage to surrounding structures, temporary bothersome urinary symptoms, incomplete stone removal, need for ureteral stenting, inability to access stone requiring subsequent procedures, and the risks of anesthesia. Very infrequently, ureteral injury may occur which typically heals with a prolonged period of ureteral stenting. It is extremely rare to need to perform additional procedures to correct ureteral injuries.
Alternatives to ureteroscopy may include surgical stone treatment with ESWL or a procedure called percutaneous nephrolithotomy where the stone is accessed through a small tube passed directly through the flank. Asymptomatic stones in absence of renal insufficiency and recurrent infection may be observed without immediate intervention.
What to do to Prepare for Surgery
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive.
You should not eat or drink anything after midnight on the day of surgery, but you may take approved home medications in the morning before surgery with a small sip of water.
What to Expect after Surgery
The surgery is typically performed in the outpatient setting under anesthesia. Blood and stone debris in the urine is expected and may persist intermittently for several weeks. You may have burning with urination and other bothersome urinary symptoms such as urgency and frequency. Lower abdominal pain and cramping is normal and related to dilation of the ureter necessary to pass the instruments. Placement of a temporary ureteral stent is usually necessary after ureteroscopy to allow the ureter to heal and to prevent postoperative swelling from obstructing the flow of urine. The stent may be completely internal or may be attached to a string exited the urethra that can be used to remove the stent at a subsequent office visit. The stent is usually removed about 3-5 days after surgery. If no string is present, the stent is removed in the office without anesthesia using a small flexible telescope passed up the urethra to grab the stent. The stent itself may cause additional urinary bother with burning, urgency and frequency as well as flank pain during voiding.