Kidney stones, referred to as nephrolithiasis, are a widespread illness impacting millions of people worldwide. These crystalline deposits develop in the kidneys as minerals and salts, producing severe distress and anguish. Medical breakthroughs have led to more efficient and less invasive procedures. Ureteroscopy is a very effective and minimally invasive method for getting rid of kidney and ureteral stones.
In this detailed blog, we will examine ureteroscopy in length, including how the procedure works, the advantages it offers, and its significance in current urology.
Understanding Kidney and Ureteral Stones
Kidney stones are hard lumps formed when urine contains high concentrations of calcium, oxalate, or uric acid. Small stones may move naturally via the urinary tract, but larger ones can become trapped, causing severe pain, infection, or even obstructing urine flow.
Ureteral stones, on the contrary, are kidney stones which travel via the ureters, which connect the kidneys to the bladder. When a stone gets stuck in the ureter, it can cause acute discomfort, feeling sick, throwing up, and trouble urinating.
What is Ureteroscopy?
Ureteroscopy is an essential procedure for treating stones in the kidney along with other urinary system problems. In this blog, that we will cover ureteroscopy in detail, detailing when and why it is advised, advantages, the possible risks, and what individuals can expect before and after the surgery.
Ureteroscopy is a key method in kidney stone removal that is frequently selected for its least invasive feature. Physicians can instantly detect and treat kidney stones by introducing a tiny probe via the urethra and into the urine tract. This type of kidney stone treatment is quite beneficial, allowing for the removal or shattering of the stones, so facilitating their natural release from the body. This procedure is an integral component in kidney stones treatment, posing fewer threats than standard surgery. It is a very useful surgery in kidney stones treatment, with a shorter recovery time. Ureteroscopy adaptability broadens the range of kidney stones and treatment choices available, making it a popular choice among both physicians and patients.
Types of Ureteroscopy (URS)
Ureteroscopy for kidney stone extraction
Ureteroscopy is performed to extract renal stones from the ureter by changing their position with forceps that end in a basket and the remaining devices. The urologist passes a small basket-like structure through the ureteroscope to catch the kidney stone and extract it from the body.
Ureteroscopy with holmium laser lithotripsy (URSL)
This is the most commonly applied procedure when the kidney stone is too big. The laser cuts the stone into smaller fragments, enabling the basket forceps to grab and remove it easily. The stone fragments can subsequently be retrieved with a basket or allowed to pass through the urine.
Ureteroscopy for placement of stent catheter
This is a procedure in which a ureteral catheter is inserted to relieve obstruction, i.e., the channel blocked by stone, internal tumors, or disease-related external material that is opened. The stents maintain urethral dilatation for easier handling of the tools during the surgery, allowing urine to pass without blockage and thereby decreasing discomfort. Stents also provide help during the healing process.
Ureteroscopy for biopsy and tumor removal
Aside from cancer treatment, Ureteroscopy can be used to reach the problematic area with laser forceps and perform a biopsy to assess whether the tumor is malignant or benign. The tool used is a brush, which is used to gather internal tissue from the afflicted location, which is usually the ureter, and then extracted for microscopic analysis.
When is Ureteroscopy Recommended?
The Ureteroscopy (URS) procedure is performed based on the kidney stone size, location, and composition as well as the patient’s health.
Small to moderate-sized stones:
• URS is best successful for stones less than 20 mm (2 cm) in size. Larger stones may necessitate various treatment strategies, such as percutaneous nephrolithotomy (PCNL) or a combination of treatments.
• Stones lodge anywhere along the ureter.
URS is effective for treating stones in the upper, middle, and lower ureters, when other non-invasive procedures may be ineffective.
Urethral stones:
• URS can effectively cure stones in the ureter, which links the kidney and bladder.
• The procedure enables direct viewing and treatment of stones in the ureter.
Renal pelvis stones:
• Kidney stones present in the collecting room of the kidney, which is the renal pelvis, can be removed with URSL.
Kidney stones those are resistant to other treatments
• URSL may be a viable option if more conservative methods, such as fluid intake or medication, have failed to help with stone passage.
Blockage and immense pain:
• Stones causing severe pain, fluid retention, or reduced kidney function can be removed using URSL.
How to Prepare For Ureteroscopy?
Planning for a ureteroscopy involves multiple steps, which are often directed by your urologist. Here are some tips about how to prepare:
Medical History and Examination:
• Notify your urologist about your current medical issues and medications you take, including over-the-counter medications, supplements, and blood thinners.
•Provide information about any allergies, particularly to anesthesia or particular drugs.
Pre-operative Testing:
Perform any necessary pre-operative testing, such as blood tests, urine tests, or imaging investigations, as directed by your healthcare urologist.
Medication Adjustments:
Several days before the procedure, your urologist might ask that you discontinue or change the dosage of certain medicines, such as blood thinners.
Fasting:
You will be required to fast (without eating or drinking) for a particular number of hours prior to the treatment. Your urologist will let you know the exact duration.
Arranging Transportation:
Make arrangements for someone to take you home following the procedure, as you may be tired from anesthesia or sedation.
Follow the Doctor’s Instructions:
Follow any further preparation instructions given by your urologist for ureteroscopy.
How is Ureteroscopy Performed?
Pre –operation procedure
- X-rays and laboratory analysis will confirm your safety during the treatment.
- You will be asked to change your clothes and pee before you are led into the operation theater.
- You will be given an intravenous (IV) or oral antibiotic prior to the surgery.
Operation procedure
- The anesthesia staff will connect monitoring equipment to you. This operation will require you to be under general or spinal anesthesia.
- After administering anesthesia, you will be asked to lie in a “lithotomy” position.
- An optical cystoscope will be introduced through the urethra to inspect the bladder’s interior.
- X-ray pictures can be obtained by introducing contrast dye into the ureters to outline the urine channel and stone placement.
- To locate the stone(s), the ureteroscope is inserted via the urethra, bladder, ureter, and kidney collecting system. No cuts or incisions are made, and the ureteroscope is introduced upstream along the natural urine flow.
- The stone can be grasped and removed with the ureteroscope by passing a tiny wire basket down the operation path.
- Large stones can be fragmented using laser or electro hydraulic energy delivered through a ureteroscope fiber.
- Depending on how much stone is present, the treatment can take one to two hours.
- Prior to being sent home following the surgery, you will typically be observed in the post-operative recovery area for two hours.
Post- procedure care
- After the procedure, a stent may be inserted in the ureter to prevent swelling from obstructing urine drainage.
- The stent is often removed within 1-2 weeks of performing ureteroscopy by a small procedure at your healthcare center.
- A thread can be affixed to the end of the bladder and taped to the skin near the urethral entrance. This permits you to remove your stent at home two or three days after treatment.
- You will be given oral narcotic medications for pain treatment at home. Other drugs may be used to ease the ureter (for example, Flomax) or to relieve inflammation and pain.
- Between 4 to 6 weeks of surgery, after removing the stent if inserted, an X-ray is taken to determine the success of the treatment and to rule out any problems.
- If you are at risk of recurring stones, further testing may be recommended to prevent future occurrences.
Benefits of Ureteroscopy
1. Short recovery period.
Most patients can resume their day to day activities within a few days of the surgery, making ureteroscopy one of the best options to patients looking to get back to regular work as soon as possible after the procedure.
2. Minimally invasive.
Unlike typical open operations, ureteroscopy does not require any incisions. The surgery is performed through natural bodily openings, reducing recuperation time and the likelihood of problems.
3. Versatility.
This type of treatment can treat several stone sizes and locations, including those immune to previous medical treatments such as extracorporeal shock wave lithotripsy (ESWL).
4. High success rate.
Ureteroscopy is highly successful at treating kidney and ureteral stones, with success rates of as high as 94% in some circumstances. This makes ureteroscopy the best choice for those with severe pain or recurring stones.
Risks associated with Ureteroscopy (URS)
While URS is generally safe and successful, it does, like any other medical procedure, carry some risks and drawbacks.
- Up to 15% of patients experience significant abdominal pain, constipation, or bladder irritation.
- Less than 5% experience severe symptoms.
- Bleeding happens during URS due to the manipulation of the instruments in the ureter and kidney which is typically minor and resolves independently.
- There can be a marginal risk of infection like bacteria due to the instruments inserted into the ureter.
- There can be minor obstructions due to small kidney stone fragments or swelling in the ureter causing pain or difficulty in passing urine. In such cases, a stent is inserted to remove the obstruction and allow easy passage of the urine.
- Small residual stone fragments may remain in the urinary tract, potentially growing over time.
- There could be an allergic reaction caused because of anesthesia or contrast dye during the procedure which is rare.
Recovery and Aftercare
Recovery from ureteroscopy is often smooth. Most patients feel minor discomfort, which can be treated with over-the-counter pain medications.
- Stay hydrated to wash out any remaining stone particles.
- Refrain from intense activity for a few days.
- Work with your urologist to monitor healing and discuss future kidney stone occurring strategies.
Ureteroscopy versus Other Kidney Stone Procedures
ESWL
How It Works: Sound waves are used to shatter stones into smaller bits, facilitating natural passage through urine.
Limitations: Limited effectiveness for large or difficult-to-reach stones compared to ureteroscopy.
Percutaneous Nephrolithotomy (PCNL)
How it works: Involves an incision in the back to directly remove large kidney stones.
Comparison: Most invasive type of surgery but necessary for very large stones.
VS
Ureteroscopy
Advantages: Minimally invasive, adaptable, and successful for a variety of stone sizes and placements.
Preventing Future Kidney Stones
Though ureteroscopy is effective in eliminating kidney stones, prevention is the key to avoiding recurrence. Make such simple life style changes in order to prevent kidney stones:
- Stay Hydrated
- Drink minimum 2 to3 liters of water daily to dilute urine and prevent stone formation.
- Adopt a Balanced Diet
- Reduce salt and animal protein consumption.
- Include foods rich in citrate, such as citrus fruits, to inhibit stone growth.
- Monitor Calcium Intake
- Plenty of diet based calcium can aid in preventing oxalate stones, but avoid too much of supplement intake.
- Regular Check-Ups
- Regular health checkups can help to detect and address risk factors early.
Conclusion
Ureteroscopy has revolutionized the treatment of kidney and ureteral stones. Its minimally invasive nature, high success rate, and fast recovery make it an excellent alternative for individuals who want effective and convenient relief from stone-related discomfort.
If you have kidney or ureteral stones, consult us at Urosonic. Our renowned Urologist specializes in Ureteroscopy which can be the best alternative for you. By selecting this innovative treatment at Urosonic, you can receive relief and return to your normal routine with minimal inconvenience.
Frequently Asked Questions (FAQs)
1. Is ureteroscopy painful?
The procedure is painless due to anesthesia, except for some mild discomfort which occurs during recovery.
2. Can ureteroscopy treat all kidney stones?
While ureteroscopy is versatile, extremely large stones cannot be treated with Ureteroscopy. It may require other surgery like PCNL.
3. Is there an age limit for undergoing ureteroscopy?
There is no age limit for undergoing ureteroscopy. However, the procedure’s acceptability will be determined by the individual’s overall health as well as their specific medical history.
4. How long does ureteroscopy take?
The procedure takes anywhere from 45 minutes to an hour, depending on the complexity of the case.
5. Is a stent always necessary?
Not all patients need a stent, but it may be placed to promote healing and prevent complications.
6. Is ureteroscopy safe during pregnancy?
While ureteroscopy is considered relatively safe, the risks and benefits must be carefully examined, particularly during pregnancy. It is critical to have a thorough discussion with healthcare specialists to decide the best treatment strategy throughout pregnancy.