Treatments

Ureteroscopy (Stone Removal)

A Ureteroscopy is an examination or procedure using a ureteroscope. A ureteroscope is an instrument used for examining the inside of the urinary tract. A ureteroscope is longer and thinner instrument used to see beyond the bladder into the ureters, the tubes that carry urine from the kidneys to the bladder.

Some ureteroscopes are flexible like a thin, long straw and others are more rigid and firm. Through the ureteroscope, the doctor can see a stone in the ureter and then remove it with a small basket at the end of a wire inserted through an extra channel in the ureteroscope. Another way to treat a stone through a ureteroscope is to extend a flexible fiber through the scope up to the stone and then, with a laser beam shone through the fiber, break the stone into smaller pieces that can then pass out of the body in the urine.

Hospital Stay: Hospital Stay: 1 day
Duration: Duration: 1-2 hrs
Cost Estimate: Cost Estimate: 1238 USD - 2464 USD These are indicative prices in Indian Hospitals

It can be diagnostic or Ureteroscopy may be required in the following conditions:

  • Frequent urinary tract infections
  • Hematuria
  • Evaluation of ureteral injury
  • Unusual cells found in a urine sample
  • Urinary blockage caused by an abnormal narrowing of the ureter
  • Kidney stone in the ureter
  • An unusual growth, polyp, tumor, or cancer in the ureter

Preparation:

People may be told not to eat before the test. And as any medical procedure has a small risk of injury, patients must sign a consent form before the test. They can ask doctor about any concerns they might have.
Patients may be asked to give a urine sample before the test to check for infection. People having ureteroscopy may receive a spinal or general anesthetic. They should arrange for a ride home after the test.

After a local anesthetic is used to take away sensation in the ureter, 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.
Patients may have a mild burning feeling when they urinate, and they may see small amounts of blood in their 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. 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.

It is a procedure in which a small scope (like a flexible telescope) is inserted into the bladder and ureter and it is used to diagnose and treat a variety of problems in the urinary tract. For ureteral stones, it allows the urologist to actually look into the ureter, find the stone and remove it. The surgeon passes a tiny wire basket into the lower ureter via the bladder, grabs the stone and pulls the stone free. This is an outpatient procedure with or without a stent inserted (a tube that is placed in the ureter to hold it open).
However, depending on the skill and experience of the surgeon, ureteroscopy can be used for virtually any stone of a size appropriate for it. Fragmentation of stones using helium laser device ureteroscopy is more assured than with shock wave lithotripsy.

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.

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