This procedure involves inserting a small endoscope into the bladder and then guiding it into the ureter to treat stones either within the ureter, up in the kidney, or both. If the stone is located within the ureter, a rigid endoscope is utilized. When stones are high up in the ureter or within the kidney, a flexible endoscope is used to allow your surgeon to see within all portions of the kidney and reach the stones.
Because the endoscopes are inserted through the normal channels of the urinary tract, no incisions are needed. If the stone is small enough, it can be extracted through the ureter with the endoscope. Stones that will not fit through the ureter can be broken up with a laser, enabling the fragments either to be removed or passed from the urinary tract. As in the case of SWL, your surgeon may choose to place a stent after treatment to make sure that the ureter does not become blocked by passing stone fragments or swelling (edema).
Before the procedure:
You will undergo an interview and physical exam along with any needed blood tests prior to the surgery. You may need to have x-rays done to confirm the number, location, and size of the stones that need to be treated.
Risks of the procedure:
In some individuals, the ureter may be very small in diameter. This may make it difficult to insert the ureteroscope and make it impossible to reach the stone. In this case, your surgeon will insert a stent to gradually and gently widen the ureter. Your surgeon will then attempt another treatment with the endoscope 7 to 10 days after stent placement, when the ureter has enlarged to an adequate diameter. Rarely, the ureter may be injured when treating a stone that has been tightly wedged or when guiding the ureteroscope through a very tortuous ureter. In this situation, a stent is placed for a few weeks to allow for healing of the injury.
Contraindications to the procedure:
Ureteroscopy should not be performed in patients with an active urinary tract infection without appropriate antibiotic treatment. Patients with bleeding problems should have these corrected if possible prior to ureteroscopic intervention. However, patients on blood thinners that cannot be stopped because of a high risk of heart or lung issues may be treated while on their medications, albeit at a higher bleeding risk.
After the procedure:
Most patients go home the same day as the procedure. Some blood in the urine (hematuria) can be expected. If a stent has been placed, you will likely experience irritation from this device that will cause an urge to urinate fairly frequently. In addition, you may have a dull aching in your back when voiding. Your surgeon will arrange for a post-operative visit with appropriate follow-up x-rays to determine that stone fragments have been cleared adequately.