A ureteroscopy is a medical procedure in which the upper urinary tract is examined with the use of an endoscope. This fiberoptic instrument reaches its destination by being guided through the urethra and bladder. The general purpose of ureteroscopy is to diagnose the presence kidney stones, although it may also be performed to remove or break them apart using laser technology. While the procedure is usually performed on an out patient basis, it does require general anesthesia. Depending on the number, size, and location of stones, the procedure may take anywhere from 30 minutes up to a few hours.
Once the patient has fallen asleep, his or her legs are placed into “stirrups,” otherwise known as the lithotomy position. This permits the physician to insert a preliminary guide wire to make passing the endoscope though the ureter easier. However, if it should prove difficult to insert the endoscope, the physician may use a balloon-like device to inflate the ureter. Again, the patient is asleep at this point and will not experience any discomfort.
Once the ureteroscopy is complete, the physician inserts a stent into the ureter to promote healing. This is only temporary. In fact, the patient usually returns to the physician’s office to remove the stent within a few days. However, in the rare event that the ureter is perforated during the procedure, a long-term “JJ” stent may be needed. In addition, follow-up surgery may be indicated to prevent stricture or narrowing of the ureter and the possible loss of kidney function.
The physician will prescribe medications to help the patient manage pain and prevent infection while recovering at home. Most patients can expect to feel some degree of discomfort in the weeks following a ureteroscopy, most notably at the site of the stent. Some patients also experience pain in their side while urinating, and may also pass small amounts of blood in the urine. In addition, if any stones were fragmented during the procedure, small pieces may also be passed. If at all possible, the patient should try to collect these specimens for further examination.
Not everyone is a candidate for this procedure. For one thing, it cannot be performed if there is any evidence of existing infection or unexplained bleeding. In addition, even though ureteroscopy provides a relatively non-invasive and scar-free alternative to open surgery, there are certain risks involved. While every care is taken to prevent damage to the ureter, it does occur on occasion and may necessitate surgery to make repairs. Finally, while up to 90 percent of kidney stones are resolved with this procedure, it does not prevent the future development of stones.
