Ureteroscopy entails the passage of a small telescope, called a ureteroscope, through the urethra and bladder and up the ureter to the point where the stone is located. If the stone is small, it may be snared with a basket device and removed whole from the ureter. If the stone is large, or if the diameter of the ureter is narrow, the stone will need to be fragmented, which is usually accomplished with a laser. Once the stone is broken into tiny pieces, these pieces are removed from the patient. In most cases, a ureteral stent is left in place temporarily following ureteroscopy, to ensure that the kidney drains urine well.
Ureteroscopy usually can be performed as an outpatient procedure however; patients may require an overnight hospital stay if the procedure proves lengthy or difficult.
Advantages of Ureteroscopy
Ureteroscopy can treat stones located at any position in the ureter and kidney. Additionally, ureteroscopy allows the treatment of stones that cannot be seen on an x-ray. Certain patients who cannot be treated with ESWL or PERC, such as those who cannot safely stop taking blood thinners, women who are pregnant, and the morbidly obese, can be treated by ureteroscopy.
Ureteroscopy is NOT a particularly good treatment for:
Patients with large stones – because ureteroscopy requires actively removing all stone fragments, the treatment of very large stones may yield so many fragments that complete removal becomes impractical or impossible.
Patients with a history of urinary tract reconstruction – the anatomy of patients who have undergone ureteral or bladder reconstruction may not allow the passage of a ureteroscope.
Ureteroscopy is a minimally invasive technique that, as the name implies, involves a small telescope, called a ureteroscope that is passed through the urethra, into the bladder, and then up the ureter to the place where the stone is located. The ureteroscope is passed to the stone by a combination of visual and x-ray guidance. Ureteroscopy is typically performed under general anesthesia, and the procedure usually lasts from one to three hours.
Depending on the nature of the stone identified with the ureteroscope, the urologist will:
If the stone is small, trap it in a basket and remove it intact.
If the stone is large, fragment it into tiny pieces with a laser.
The passage of the ureteroscope may result in swelling in the ureter. Therefore, it may be necessary to temporarily leave a small tube, called a ureteral stent, inside the ureter.