ureteroscopy

Ureteroscopy

Ureteroscopy is a procedure in which a small scope (like a flexible telescope) is inserted into your urinary bladder and ureter and it is used to diagnose and treat a variety of problems in the urinary tract. For ureteral stones, ureteroscopy allows the urologist to actually look into the ureter, find the stone and remove it. The surgeon passes a tiny wire basket into the lower ureter via the bladder, grabs the stone and pulls the stone free. Ureteroscopy is an outpatient procedure with or without a stent inserted (a tube that is placed in the ureter to hold it open). Ureteroscopy procedure usually takes 1 hour.

However, depending on the skill and experience of your surgeon, ureteroscopy can be used for virtually any stone of a size appropriate for it. Fragmentation of stones using helium laser device ureteroscopy is more assured than with shock wave lithotripsy.

During a ureteroscopy, a urologist can see

  • a stone in a ureter or kidney
  • abnormal tissue, polyps, tumors, or cancer in a ureter or in the lining of a kidney

Ureteroscopy is performed with a ureteroscope. This is a small tube (rigid or flexible) with a tiny light and camera on the end. During the ureteroscopy procedure:

  • You are given general anesthesia. This is medicine that allows you to sleep.
  • Your groin and urethra are washed. The scope is then inserted through the urethra, into the bladder, and then up into the ureter.
  • Your doctor may use small instruments that are sent through the scope to grab and remove kidney stones or break them up using a laser.
  • Place a stent in the ureter to allow urine and small pieces of kidney stone to pass through. If you have a stent, you will need to return to have it removed in 1 or 2 weeks. This can usually be done in the doctor’s office without anesthesia.
  • Check for cancer.
  • Examine or remove a growth or tumor.
  • Examine areas of the ureters that have become narrow.
  • Diagnose repeated urinary tract infections and other problems.

During a ureteroscopy, a urologist can treat problems such as urine blockage in a ureter. The urologist can also

  • remove a stone from a ureter or kidney
  • remove or treat abnormal tissue, polyps, and some types of tumors
  • perform a biopsy of a ureter or kidney

Most often ureteroscopy is used for stones in the ureter, especially for stones closest to the bladder, in the lower half of the ureter. lt is the most common treatment of lower ureteral stones. For stones in the kidney, shock wave lithotripsy is the most common treatment. Shock wave lithotripsy treatment cannot be used in everyone. For patients who are pregnant, morbidly obese, or have a blood clotting disorder, ureteroscopy is a good choice. For very large or oddly shaped stones, or stones that are very hard, other treatments such as percutaneous nephrolithotomy or rarely, open surgery may be needed.

After a ureteroscopy, the urologist may need to place a stent in a ureter to drain urine from the kidney to the bladder while swelling in the ureter goes away. The stent, which is completely inside the body, may cause some discomfort in the kidney or bladder area. The discomfort is generally mild. The stent may be left in the ureter for a few days to a week or more. The urologist may need to perform a cystoscopy to remove the stent in the ureter.

ls a basket always used during ureteroscopy?

Not always. In addition to the basket, the surgeon using ureteroscopy has several other options for stone treatment. lf the stone is too large or too tightly stuck in the ureter, it can be fragmented with a laser (pulsed dye laser), shock waves (high frequency sound waves) or electricaI energy (electrohydrauIic lithotripsy).

Will I be hospitalized?

Most often, ureteroscopy is an outpatient procedure.

What is ureteroscopy recovery time?

Most people are able to go home the same day of the ureteroscopy procedure. But you may need to stay in the hospital. If you do, the stay is usually no more than 24 to 48 hours. For several hours after the procedure you may have a burning feeling when you urinate. This feeling should go away within a day. Drinking a lot of water can help reduce the burning. Your doctor also may recommend you take medicine to numb the burning. You may also have some blood in your urine for 2 or 3 days. You will likely feel better in about 5 to 7 days after your ureteroscopy procedure. If you have a stent, it may take longer to feel like yourself again. The stent may be left in the ureter for a few days to a week or more. The urologist may need to perform a cystoscopy to remove the stent in the ureter. Treating kidney stones using ureteroscopy usually has a good outcome.

Ureteroscopy procedure

Before the ureteroscopy procedure

Your urologist will ask about your medical history, current prescription and over-the-counter medications, and allergies to medications, including anesthetics. Tell your urologist what medicines you are taking, including ones you bought without a prescription. Your urologist will talk about which anesthetic is best for the ureteroscopy procedure and explain what you can expect after the ureteroscopy procedure. You’ll need to arrange to have someone take you home after the ureteroscopy procedure.

Follow instructions about how to prepare for the ureteroscopy procedure. These may include:

  • Not eating or drinking anything after the midnight prior to your procedure.
  • Temporarily stopping certain medicines, such as aspirin or other blood thinners. Do not stop taking any prescription medicines unless your doctor tells you to stop.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • Ask your doctor when to empty your bladder before the procedure

You may need to give a urine sample to test for a UTI (urinary tract infection). If you have a UTI, your urologist may treat the infection with antibiotics before performing a ureteroscopy.

Ureteroscopy procedure

A urologist performs a ureteroscopy during an office visit or in an outpatient center or a hospital. For some patients, the urologist will apply an anesthetic gel around the urethral opening or inject a local anesthetic into the urethra. Some patients may require sedation or general anesthesia. The urologist often gives patients sedatives and general anesthesia for a:

  • ureteroscopy
  • cystoscopy with biopsy
  • cystoscopy to inject material into the wall of the urethra
  • cystoscopy to inject medication into the bladder

For sedation and general anesthesia, a nurse or technician places an intravenous (IV) needle in a vein in your arm or hand to give the medication. Sedation helps you relax and be comfortable. General anesthesia puts you into a deep sleep during the procedure. The medical staff will monitor your vital signs and try to make you as comfortable as possible. During a ureteroscopy procedure, a woman will lie on her back with the knees up and spread apart. During a ureteroscopy procedure, a man can lie on his back or be in a sitting position.

After the anesthetic has taken effect, the urologist gently inserts the tip of the ureteroscope into the urethra and slowly glides it through the urethra and into the bladder. A sterile liquid—water or salt water, called saline—flows through the ureteroscope to slowly fill the bladder and stretch it so the urologist has a better view of the bladder wall. As the bladder fills with liquid, you may feel some discomfort and the urge to urinate. The urologist may remove some of the liquid from the bladder during the procedure. As soon as the procedure is over, the urologist may remove the liquid from the bladder or you may empty your bladder.

For a ureteroscopy, the urologist passes the ureteroscope through the bladder and into a ureter. The urologist then examines the lining of the ureter. He or she may pass the ureteroscope all the way up into the kidney. The urologist can insert small instruments through the ureteroscope to treat problems in the ureter or kidney or perform a biopsy.

When a urologist performs a ureteroscopy to make a diagnosis, ureteroscopy procedure—including preparation—take 15 to 30 minutes. The time may be longer if the urologist removes a stone in the bladder or a ureter or if he or she performs a biopsy.

lf the ureter is too small, a stent may be left in place for one or two weeks to keep the ureter open and then the ureteroscopy procedure is performed at a later date.

Ureteroscopy risks

During the ureteroscopy procedure there is a small chance of infection, bleeding, or injury to the ureter.

Risks of surgery and anesthesia in general are:

  • Problems breathing
  • Reaction to medicines
  • Bleeding, blood clots, infection

Risks of ureteroscopy procedure include:

  • Injury of the urethra, ureters or kidneys
  • Urinary tract infection (UTI)
  • Narrowing or scarring of the ureter or urethra
  • Abdominal pain
  • A burning feeling or pain during urination
  • Inability to urinate due to swelling of surrounding tissues

Ureteroscopy recovery

You will wake up in a recovery room. You can go home once you are awake and can urinate. Most patients go home the same day as the procedure. Recovery depends on the type of anesthesia. A patient who receives only a local anesthetic can go home immediately. A patient who receives general anesthesia may have to wait 1 to 4 hours before going home. Your health care provider usually asks you to urinate before leaving. In some cases, you may need to stay overnight in the hospital. Your health care provider will provide discharge instructions for rest, driving, and physical activities after the procedure.

After a ureteroscopy, you may:

  • have a mild burning feeling when urinating
  • see small amounts of blood in the urine. You may have some blood in your urine for 2 or 3 days.
  • have mild discomfort in the bladder area or kidney area when urinating
  • need to urinate more frequently or urgently

These problems should not last more than 24 hours. You should tell your urologist right away if bleeding or pain is severe or if problems last more than a day.

At home, follow any instructions you’re given. These may include the following:

  • You will need to rest for 24 hours. You should have someone stay with you during that time.
  • Your doctor will likely prescribe medicines for you to take at home. This may include a pain medicine and an antibiotic to prevent infection. Take these as instructed.
  • Drink 4 to 6 glasses of water a day to dilute your urine and help flush out your urinary tract.
  • You will see blood in your urine for several days. This is normal.
  • You may feel pain in your bladder and burning when you urinate. If your doctor says it’s OK, sitting in a warm bath (sitz bath) may help relieve the discomfort. Using a heating pad set on low can also help.
  • You may hold a warm, damp washcloth over the urethral opening to relieve discomfort.
  • If your doctor placed a stent, you may feel pain in your side, especially during and right after urination.
  • You can drive after you’ve stopped taking any narcotic pain relievers.

You will likely feel better in about 5 to 7 days. If you have a stent, it may take longer to feel like yourself again.

You should report any signs of infection—including severe pain, chills, or fever—right away to your health care provider.

Heat

  • Take a warm bath. This may soothe the burning.
  • You also can hold a warm face cloth over your urethra for comfort. (The urethra is where your urine comes out.)

Activity

  • You can go back to work and other activities the next day.

Diet

  • Try to drink two 8-ounce glasses of water each hour for 2 hours after the ureteroscopy procedure. This may help ease the burning when you urinate.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
  • If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
  • If you take medicine to stop the burning when you urinate, take it exactly as recommended. Be safe with medicines. Call your doctor or nurse call line if you think you are having a problem with your medicine. You will get more details on the specific medicine your doctor recommends.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label. Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
When to seek immediate medical care

Call your local emergency services number anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have chest pain, are short of breath, or cough up blood.

Call your doctor now or seek immediate medical care if:

  • you’re unable to urinate with the feeling of a full bladder
  • you have a burning or painful urination that lasts more than 2 days
  • you have bright red urine or more blood clots in the urine (It is normal for the urine to be pink for a few days.)
  • you have a fever, with or without chills
  • you have severe discomfort
  • you have pain that does not get better after you take pain medicine.
  • you have symptoms of a urinary tract infection. These may include:
    • Pain or burning when you urinate.
    • A frequent need to urinate without being able to pass much urine.
    • Pain in the flank, which is just below the rib cage and above the waist on either side of the back.
    • Blood in the urine.
    • A fever.
  • you are sick to your stomach or cannot drink fluids.
  • you have signs of a blood clot in your leg (called a deep vein thrombosis), such as:
    • Pain in the calf, back of the knee, thigh, or groin.
    • Redness and swelling in your leg.