Ureteroscopy
Ureteroscopy can be performed to treat stones in the ureter (the drainpipe of the kidney), or in the kidney itself. Usually, rigid ureteroscopy is only performed for stones in the ureter.
The main reason for this procedure is to remove a stone that continues to cause pain, or has not passed. Even though a stone may not be causing any pain, if it is left in place it can cause permanent damage to the kidney.
It can also put you at risk of infection which can be very serious.
Procedure
The procedure is done under general anaesthetic.
A ureterocope (a long thin metal camera) is placed into your urethra and into the ureter via the bladder.
Once the stone is located, the laser can be introduced via a channel within the camera, and the stone is lasered into very fine fragments which you either pass or are removed with a tiny basket.
Depending on the size and position of the stone the procedure will take 30- 90 minutes.
Post-procedure
Normally, you are able to go home on the same day as your surgery. If you live out of town, or the procedure has been long, it is often worthwhile staying overnight. Paracetamol and anti-inflammatory medication (eg Voltaren or Brufen) are usually all that is required.
Follow-up after Surgery
We need to do an x-ray after the procedure, to check that the stone has been fully cleared, and if it hasn’t, what is involved in a second procedure. We would normally see you six weeks after surgery for a plain x-ray.
If you have a stent, we would always try to take this out 1 to 2 weeks after surgery if possible. Occasionally, the stent is left in longer to allow fragments to pass. Even if an x-ray at six weeks is clear, to be completely safe, we often do an ultrasound scan 3 to 6 months after surgery.
Risks of Ureteroscopy
Stones in the ureter can be very challenging, despite tame appearances!
This is delicate surgery as the ureter is very small and fragile, and we are always extremely careful to avoid damage to the ureter. If there are any concerns that damage to the ureter may occur, the procedure is usually abandoned and a ureteric stent placed (See below). This is because the worst-case scenario of a ureteric injury is that the ureter completely ruptures, which requires a large operation involving a large incision in your abdomen. Thankfully this is very, very rare!
Another risk is that the stone cannot be accessed, or that the whole stone cannot be lasered. The risk of needing to come back for a second procedure is usually 5 to 10%. Again, safety is paramount.
It is not unusual to see some blood in your urine for a few days after the procedure. This is almost always minor.
There is a small risk of urinary infection, and we give you antibiotics while you are under anaesthetic.
Ureteric stents
A ureteric stent is a fine tube that is placed at the end of the procedure. It runs from the kidney down inside the ureter to the bladder.
We place a stent for several possible reasons;
It has been too difficult to access the ureter with the camera, and a stent makes a second procedure much more straightforward.
The procedure has been successful, but there is a risk that the ureter may block due to small stone fragments or swelling of the ureter itself. As the ureter is quite small, even a small amount of swelling may block it, replicating the pain of a stone. In this case, the stent is usually only in place for a week or two.
There are residual stones left behind, meaning you need a second procedure. The stent helps to stretch out the ureter, making access to the stone a lot easier. In this case, the stent stays in place until all the stones have been treated.
We only ever put in a ureteric stent if we think you need it. The majority of patients will not need a stent. If the stent has been placed, you may notice some symptoms related to it.
These include:
pain in your kidney when you pass urine,
frequency and urgency (needing to run to the toilet).
bladder pain - we can give you some medication to try and minimise the symptoms. If the stent has been placed, we endeavour to keep it in place for as short a time as possible.
