Ureteroscopy is a minimally invasive method to treat kidney stones as well as stones located in the ureter. It is performed in the operating room with general or spinal anesthesia, and is typically an out-patient procedure (you go home the same day).
The urologist will insert a thin fiberoptic ureteroscope into the natural urinary channel. Once the stone is identified, it can be fragmented and/or removed. Ureteroscopy can also be performed in patients who must remain on anticoagulation therapy.
What you should anticipate:
- Lab tests and X-rays will be obtained to ensure your safety during the procedure.
- You will receive an antibiotic, either by mouth or through an IV, right before the procedure.
- The anesthesia team will attach monitoring devices to you. You will be placed under general or spinal anesthesia for this procedure.
During the procedure
- Once you are under anesthesia, you will be positioned on your back with legs elevated in “lithotomy” position
- The inside of the bladder will be examined with an optical cystoscope inserted through the urethra.
- X-ray images with contrast (dye) instilled in the ureters may be created to outline the urinary channel and stone location.
- The ureteroscope will be passed through the urethra, into the bladder, up the ureter, and into the collecting system of the kidney to reach the stone(s). No incisions are made; the ureteroscope is passed upstream through the natural urinary channel.
- A small wire basket can be passed through the working channel within the ureteroscope to grasp and extract the stone.
- If the stone is too large to be easily removed, it can be fragmented by delivering laser or electrohydraulic energy through a fiber inserted through the ureteroscope.
- The procedure time varies based on the amount of stone present but generally takes 1-2 hours.
- After the procedure, you will be monitored in the post-operative recovery area, usually for about 2 hours, before being discharged home.
- In some patients a temporary, internal, plastic tube, called a stent, will be placed within the ureter at the end of the procedure to ensure that swelling does not block the drainage of urine.
- Generally, the stent will be removed 1 to 2 weeks after ureteroscopy with a minor procedure in your urologist’s office.
- Sometimes a thread will be attached to the end of the stent in your bladder and taped to your skin near the opening of the urethra. This will allow you to remove your own stent at home 2-3 days after the procedure
- You can expect your urine to be bloody for several days after the procedure or until the ureteral stent is removed (if one was placed).
- You will be provided with oral narcotic tablets for pain relief at home. You may also receive other medications to relax the ureter (i.e. Flomax [tamsulosin]) or to reduce inflammation and pain (examples include Pyridum [phenazopyridine] and Motrin [ibuprofen]).
- You should avoid strenuous activity or heavy lifting for several days after the procedure or until the stent is removed. Most people can then resume normal activities without pain.
- You will have a follow up visit with your Urologist either
- Within 1-2 weeks to remove your stent, if one was placed without a thread.
- Within 4-6 weeks after surgery if a stent was not required or was removed at home. At that time, an X-ray will be performed to determine the procedure’s success and to assess for any complications.
- Depending on your risk of stone recurrence, you may be offered further testing to help prevent future stones.