ureteroscopy (URS)

What is involved in the ureteroscopy (URS) procedure?

Ureteroscopy, a minimally invasive medical procedure, involves the use of a thin, flexible or rigid tube called a ureteroscope to examine and treat conditions within the urinary tract, specifically the ureter and the kidney. This versatile technique is commonly employed for diagnosing and addressing issues such as kidney stones, ureteral strictures, and tumors. Ureteroscopy offers the advantage of direct visualization, allowing urologists to navigate the intricate structures of the urinary system with precision. Indicated in various cases, it is particularly useful for treating smaller stones or those located in challenging anatomical positions.

Indications for Ureteroscopy: Ureteroscopy is indicated in situations where kidney stones or other urinary tract abnormalities require intervention. It is particularly recommended for smaller stones that may not be effectively treated with conservative measures alone. Ureteroscopy becomes crucial in cases where the stones cause symptoms like severe pain, urinary obstruction, or recurrent urinary tract infections. Additionally, it is employed to investigate and address conditions such as ureteral strictures and tumors that might be affecting the normal function of the urinary system.

Ureteric Stent: In certain ureteroscopy procedures, a ureteric stent may be utilized. This small, flexible tube is placed into the ureter to allow urine to flow freely from the kidney to the bladder and alleviate any potential blockages. Ureteric stents are often employed to facilitate the passage of stone fragments after ureteroscopy and can be left in place temporarily to aid in the healing process. While providing essential relief, the presence of a ureteric stent can also cause some discomfort, and its duration of use is determined by the specific needs of the patient and the nature of the underlying condition.

Ureteroscopy uses a thin scope to treat urinary conditions.

Laser breaks stones for non-invasive kidney stone treatment.


URS main points

Key Points:

  • The procedure aims to fragment stones in the ureter or kidney using a thin telescope passed through the urethra.

  • A "semi-rigid" telescope (ureteroscope) treats stones in the ureter, while a flexible ureteroscope is used for kidney stones.

  • Laser energy, transmitted through a small laser fiber, is commonly employed to break up stones.

  • Ureteroscopy has significantly reduced the necessity for open surgery in stone removal.

  • If stones are too large for ureteroscopy, alternatives such as laparoscopic, robotic-assisted, or open surgery may be considered.

surgery

What occurs on the day of the procedure?

A/Prof Homi Zargar will discuss the surgery once again to ensure your understanding and obtain your consent. An anaesthetist will meet with you to explore the options of a general or spinal anaesthetic and discuss post-procedure pain relief.

Details of the procedure:

  • Antibiotics are given after allergy checks for infection prevention.

  • A telescope is inserted through the urethra into the bladder.

  • A guidewire is advanced into the kidney under X-ray control.

  • The ureteroscope is guided to the stone using the guidewire.

  • Stone fragmentation is done using laser or, rarely, lithoclast.

  • Laser may "dust" the stone or break it into fragments.

  • A temporary drainage tube (stent) may be inserted into the ureter.

  • A "second-look" ureteroscopy may be performed if needed.

  • Some patients may go home on the same day.

After-Effects and Risks of the Procedure:

  • Mild burning or bleeding during urination may occur briefly following the procedure, particularly if a ureteric stent is present (Almost all patients).

  • Temporary placement of a ureteric stent is part of the procedure, and it will require removal at a later time (Almost all patients).

  • Recurrent (new) stone formation within the next five to 10 years, necessitating additional surgery or alternative treatments (1 in 20 patients).

  • Residual stones that may require further surgery or other interventions, with a higher likelihood for stones situated closer to the kidney (Between 1 in 7 & 1 in 20 patients).

  • Difficulty accessing the ureter or reaching the stone, leading to the need for additional surgery or alternative treatments (1 in 20 patients)..

  • Temporary insertion of a bladder catheter as part of the procedure (Between 1 in 10 & 1 in 50 patients).

  • Infection arising, requiring antibiotic treatment (Between 1 in 10 & 1 in 50 patients).

  • Minor damage to the ureter wall, such as small perforations, mucosal abrasion, or bleeding, may necessitate stenting or percutaneous nephrostomy (1 in 100 patients).

  • Ureter narrowing due to delayed scar formation (stricture), potentially requiring further treatment (Between 1 in 100 & 1 in 250 patients).

  • Major damage to the ureter wall, including large perforations or avulsion, may necessitate additional surgery (Less than 1 in 1000 patients).

  • Possible anesthetic or cardiovascular complications that may necessitate intensive care, encompassing issues like chest infection, pulmonary embolism, stroke, deep vein thrombosis, heart attack, and potential fatalities(Between 1 in 50 & 1 in 250 patients).