Ureteroscopy

This card describes ureteroscopy, a way of reaching stones in the ureter or kidney without a cut in the skin. It is written for patients, families and students who want a first map of the procedure, and it is general education only. The treating urologist decides what suits a particular person. Related cards cover laser lithotripsy, ureteral stents and the wider stone procedures drawer.

What it is

Ureteroscopy is done with a ureteroscope, a small tube, either rigid or flexible, with a light and a tiny camera or lens at the tip (MedlinePlus). The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says a ureteroscope is longer and thinner than the cystoscope used to look into the bladder, which lets the urologist see the lining of the ureters and kidneys. Cleveland Clinic explains that a rigid scope is used for the lower ureter near the bladder, and a flexible one for the upper ureter and the kidney.

The ureter is the narrow tube that carries urine from each kidney to the bladder, and a viewing instrument passed into the body like this is an endoscope.

Why it is done

NIDDK says urologists use ureteroscopy to find the cause of a blockage in a ureter or to look at other problems inside the ureters or kidneys. During the procedure the urologist can see a stone and can remove it or break it into smaller pieces. Cleveland Clinic names stones and other blockages, such as narrowings or growths, as the most common reasons.

The same source lists situations in which it might be a good option for a stone: several stones in the kidneys, a blocking stone that will not pass, pregnancy, obesity, a blood-clotting disorder, or the use of blood thinners. It gives a stone size range of 5 to 20 millimeters, and notes that ureteroscopy can break up stones that shock wave lithotripsy cannot. Larger stones may be handled differently, for example with percutaneous nephrolithotomy.

How it is done, in outline

NIDDK says ureteroscopies are usually performed in an operating room under anesthesia, and MedlinePlus describes general anesthesia, which means the person is asleep. The scope passes through the urethra into the bladder and then up into the ureter. MedlinePlus says the procedure usually takes about 1 hour, while Cleveland Clinic gives one to two hours and suggests planning on at least four hours at the facility.

Small instruments can be passed through the scope. For a small stone, Cleveland Clinic says the urologist may use a basket to collect it or a laser to break it up. For larger stones, a flexible laser fiber breaks the stone into tiny pieces or dust, and the pieces are suctioned or flushed out or leave later in the urine. The approach depends on the location, size and mineral makeup of the stone.

Afterward, a temporary stent may be placed in the ureter. NIDDK says this happens sometimes, and Cleveland Clinic describes it as the usual practice, so sources differ on how routine it is. MedlinePlus says a stent is removed 1 or 2 weeks later, usually in the surgeon's office.

Recovery

People are monitored in a recovery room for an hour or two, and ureteroscopy is generally an outpatient procedure (Cleveland Clinic). MedlinePlus says a person can go home once awake and able to urinate, should rest for 24 hours with someone nearby, and will see blood in the urine for several days, which it calls normal. It also suggests drinking at least 4 to 6 glasses of water a day. Most people feel better in about 5 to 7 days, and it may take longer with a stent.

Cleveland Clinic says stone pieces can take eight weeks or longer to clear completely. NIDDK advises calling or seeing a health care professional right away if there is an inability to urinate with a full bladder, burning or painful urination that lasts more than 2 days, bright red urine or blood clots, fever with or without chills, or severe discomfort. Cleveland Clinic advises going to an emergency room for a fever above 101 F (38 C), uncontrollable nausea or vomiting, or being unable to urinate for six hours.

Risks

MedlinePlus lists injury to the ureter or kidney, urinary tract infection, and narrowing or scarring of the ureter, along with the general risks of anesthesia. Cleveland Clinic also mentions temporary difficulty emptying the bladder, which may need a catheter, and a stent that falls out. If there are many or very large stones, a second procedure may be needed to clear them. Cleveland Clinic describes the overall risk of major problems as low.

Questions to ask your clinician

• Why is ureteroscopy being suggested for my stone rather than another procedure?
• Will a rigid or a flexible scope be used, and what will happen to the stone?
• Will I have a stent afterward, and when and how will it be removed?
• What kind of anesthesia will I have, and how long should I plan to stay?
• Is there a chance I will need a second procedure to clear all the stones?
• Which symptoms should I expect, and which should make me call you right away?
• Will the stone be sent for analysis, and how could that guide prevention?