Ureteroscopy

What is a ureteroscopy?

A ureteroscopy is an outpatient procedure most commonly done to treat stones in the ureters (the tubes that connect the bladder to the kidneys) or kidney. It may also be used to evaluate and treat other causes of kidney blockage or blood in the urine.

A ureteroscopy is done with a ureteroscope, a long, thin tube that has an eyepiece on one end and a tiny lens and a light on the other end. In general, there are two ways to perform ureteroscopy for stones:

  • If the stone is small, your doctor will insert a scope into the ureter to remove the stone. The type of scope used in this procedure will have a small basket at the end of a wire that is run through an extra channel in the ureteroscope. The basket is used to collect the stone.
  • In cases when the stone is larger, your doctor will extend a flexible fiber through the scope up to the stone. With a laser beam shining through the scope, the doctor will break the stone into pieces small enough to be passed out of the body with urine.

Based on the location, size, and what the stone is made of, Dr. Delgadillo will determine the best ureteroscopy treatment option for you.

We are able to see inside the ureter and perform various procedures including the use of a small laser fiber to break stones into small fragments. We also have tiny wire baskets that we can use to grab small pieces of stones and remove them outside the body.

Kidney Stone in basket that is placed through the ureteroscope camera.

Stone captured in a small basket that is placed through the ureteroscope camera.

Almost all types of stones may be treated with ureteroscopy. Obviously, the larger the stone is, the longer it may take to break and remove each piece.

At the end of the procedure, a stent will be left in place (plastic tube) inside the ureter with a tip in the bladder. The stent is placed because the ureter gets swollen after instrumentation and the swelling may block the kidney after surgery (just like if you hit your finger, it gets swollen).

This surgery is normally done in the outpatient setting and thus patients are sent home same day unless there are other health problems that require an admission to the hospital.

What it involves?

After patients are asleep with regional anesthesia, patients lay on their back in stirrups. Dr. Delgadillo initially uses a small camera to look inside the bladder and place a small wire up to the kidney that has the kidney stone. Using the wire as our guide, he places the thinner camera (ureteroscope) and may see the entire drainage tube (ureter) as well as the inside of the kidney.

Once the stone is identified, a special tiny laser fiber is used to crack the stone into very fine fragments which then are left to pass naturally or if large enough are then removed with tiny baskets that are placed through the camera.

At the end of the procedure, most surgeons leave a stent to help the ureter recover from the surgery.

Why do I need to have a ureteroscopy?

Your doctor may suggest a ureteroscopy if you have one or more of the following conditions:

  • Stones in the kidney or ureter.
  • Blood in the urine.
  • Unusual cells in a urine sample.
  • Scarring of the ureter.
  • A growth, polyp, tumor, or cancer in the ureter.

Am I a good candidate for a ureteroscopy?

If you have a ureteral stone close to the bladder, especially in the lower half of the ureter, then ureteroscopy is the most effective type of treatment. Ureteroscopy is also a good option for pregnant women, obese patients, and those who suffer from a blood clotting disorder.

Length of Surgery

Lasering (laser fiber in blue) of a stone (yellow) done through the ureteroscope.

Ureteroscopy length of surgery primarily depends on the size of the stone. Most ureteroscopy procedures take about 1-2 hours to complete.

Anesthesia General anesthesia (heavy sedation with a ventilator) is recommended for best results. With general anesthesia, we are able to control patient’s breathing and thus allow for better targeting of the stone as we use the laser to break the stone.

What should I expect after a ureteroscopy?

Since you will have a general anesthetic during the procedure, you should arrange for a ride home.

For the first 2 days after the procedure, your doctor may prescribe an antibiotic medication to prevent an infection. Signs of infection include fever, chills, and worsening pain. Tell your doctor if you notice any of those signs.

Most ureteroscopy patients have mild to moderate pain that can be managed with medications. To relieve mild pain:

  • You should drink two 8-ounce glasses of water every hour in the two hours after the procedure.
  • With your doctor’s permission, you may take a warm bath to relieve the pain.
  • You can apply a warm, damp washcloth over the urethral opening.
  • Ice packs or heating pads for the kidney may help with the pain.

Other side effects include cramps in the kidney and bladder or burning with urination. Urine may look pink or red (which is a sign to drink more fluids). These symptoms may last until the stent is removed.

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