Treatments

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 (SWL) is the most common treatment. SWL 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 an appropriate anesthetic is given, the doctor gently inserts the tip of the cystoscope or ureteroscope into the urethra and slowly glides it up into the bladder. A sterile liquid-water or salt water, called saline-flows through the scope to slowly fill the bladder and stretch it so the doctor has a better view of the bladder wall.
As the bladder is filled with liquid, patients feel some discomfort and the urge to urinate. The doctor may then release some of the fluid, or the patient may empty the bladder as soon as the examination is over.
The time from insertion of the scope to removal may be only a few minutes, or it may be longer if the doctor finds a stone and decides to treat it. Taking a biopsy-a small tissue sample for examination with a microscope-will also make the procedure last longer. In most cases, the entire examination, including preparation, takes 15 to 30 minutes.

There may be a mild burning feeling when urinating, and may see small amounts of blood in urine. These problems should not last more than 24 hours. Patients should tell their doctor if bleeding or pain is severe or if problems last more than a day.
To relieve discomfort, you should drink two 8-ounce glasses of water each hour for 2 hours after the procedure. You may take a warm bath to relieve the burning feeling. If not, you may be able to hold a warm, damp washcloth over the urethral opening.
The doctor may prescribe an antibiotic to take for 1 or 2 days to prevent an infection. Any signs of infection-including severe pain, chills, or fever-should be reported to a doctor.

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).

There is a small chance of infection, bleeding, or injury to the ureter. 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 procedure is performed at a later date.