What are the reasons for having ureteroscopy?
Ureteroscopy is performed for the following reasons:
- stones typically in the ureter that are unlikely to pass spontaneously or are causing significant discomfort (removed by rigid ureteroscopy)
- stones in the kidney that are not treatable by ESWL (extracorporeal shock-wave lithotripsy)
- to determine the reason for blood in the urine
What are the advantages of ureteroscopy over other treatments?
The stone is usually seen directly, allowing the delivery of special instruments or lasers to break it up. The ureteroscope is passed through natural channels in the body and involves no skin incisions. If the stone can be seen, there is a very high chance that the stone will be broken up in one session.
Flexible ureteroscopy allows entry into all parts of the kidney so that all stones can be removed or broken up provided they are of an appropriate size and accessible.
What are the success rates of ureteroscopy?
The success rate of ureteroscopy is higher than 90% for the majority of stones that are treated this way. Success depends on:
- whether one stone or more present
- how long the stone has been stuck
- the location of the stone (where in the kidney or ureter)
• the size of the stone
• whether you have had previous surgery in the kidney
• the experience of the urologist treating you
What are the risks of ureteroscopy?
The risks include:
- urine infection: this usually requires antibiotics only
- bleeding: this usually settles quickly
- damage to the ureter resulting in narrowing of the ureter (‘stricture’) or perforation: this is rare and may require stretching by a balloon and insertion of a double-J stent
- failure to break and retrieve the stone: an alternative procedure may be necessary
- perforation of the ureter: usually a double-J stent is required for a few weeks after such an injury
- detachment (‘avulsion’) of the ureter from kidney: this is very rare and sometimes unavoidable but may require open surgery to repair
- abdominal or back discomfort
- • side-effects due to a double-J stent
What are the alternatives to ureteroscopy?
Other treatment options include:
- ESWL: This treatment is suitable mostly for stones in the upper ureter and the kidney limited to a certain size. It can be used for stones in the lower ureter near the bladder, although ureteroscopy tends to be chosen by many urologists.
- PCNL (percutaneous nephrolithotomy): This procedure is very good at removing stones in the kidney and upper ureter but involves making a small incision in the back and passing a tube through the kidney. For the latter reason, it is more invasive than ureteroscopy.
- Laparoscopic or open surgery: This is more successful than ureteroscopy but involves making several incisions and requires a longer hospital stay. There is greater risk of infection as a result, although the absolute risk is still quite small. This approach is usually tried after all other therapies have failed.
How often does ureteroscopy need to be repeated?
It may not be possible to reach the stone on the first attempt with the ureteroscope because of severe swelling that occurs when a stone is present in the ureter. In that situation, a double-J stent may be placed in the ureter. With a double-J stent in place, urine can drain from the kidney to the bladder and the ureter expands in size. As it becomes wider, it is easier to pass the ureteroscope up to the stone and remove it.
Sometimes if the stone is very large, it may not be possible to remove the stone in one session and a second procedure may be necessary. On other occasions, small stone fragments or the whole stone may pass up into the kidney. If a flexible ureteroscope is available, it can be passed up into the kidney and the fragments removed or broken with a laser.
What is the difference between rigid and flexible ureteroscopy?
The difference is in the use of a rigid or flexible ureteroscope. Rigid ureteroscopy is performed, literally, with a rigid telescope. As such, it sees only in a straight line. Flexible ureteroscopy is performed with a very thin and flexible telescope that can perform almost 270° turn and look back on itself. Using a laser, stones can be vaporised and removed. Flexible ureteroscopy tends to be used for stones in the kidney and near the kidney in the upper ureter. Rigid ureteroscopy is used mainly for stones in the lower and midureter closer to the bladder. Flexible ureteroscopy is more gentle than rigid ureteroscopy.
What reduces the risk of more stones in the future?
The following steps can reduce the chance of having significant stones in the future:
- Drink more fluid (especially 2 hours after meals and at night)
- Adopt a diet appropriate to the type of stone (see calcium stone diet)
- Periodic x-rays or ultrasound to determine if more stones are being formed
- Follow-up by a stone clinic
Will I have stitches from the surgery?
There will be no stitches from the surgery. The ureteroscope is passed through natural channels in the body and involves no skin incisions.
How soon after the procedure can I shower or bathe?
The day after the surgery.
What is the purpose of the catheter?
Sometimes there is blood or kidney stone residual in your urine because of the surgery. Most of the time there is small amount of blood in the ureter or bladder. If necessary, the bladder can be flushed through the catheter. When no blood is visible in the urine, the catheter can be removed. This is usually on the first day after the surgery.
When will the urine catheter be removed after the procedure?
This is usually on the first day after the surgery.
What is the purpose of the stent?
The stent makes the flow of urine from the kidney to the bladder easier, and it prevents attacks of colic pain (severe pain caused by cramping in the urinary tract).
When will the inserted stent be removed after the procedure?
An x-ray will be taken several weeks after the surgery. If no stones are visible, the stent will be removed.
How much experience does a urologist need with this procedure?
A surgeon’s experience in doing a procedure may influence the results. For example, when complications arise during a procedure, a skilled surgeon is more likely to better control them.
Although there is no magic number of operations that make a surgeon proficient, it might give you a good indication to ask:
- How many ureteroscopies do you do each year?
- How long have you been doing this surgery?
Do I need to go to the nutritionist to check on my eating behaviour to prevent more stones?
The development of kidney stones can have different causes. Most kidney stones are ‘calcium oxalate’ stones. Oxalates are made within our own bodies. Oxalates are also naturally found in fruits, vegetables, legumes, coffee, tea, and nuts and protect the plant from being eaten by pests. Most high-oxalate foods taste bitter when eaten raw. When consumed in high amounts, oxalates and calcium bind together to form crystals, and these crystals eventually form a stone.
- Eat fewer foods with oxalate—these foods include leafy greens like spinach and root vegetables like beets, soybeans and soybean meal.
- Moderate animal protein—animal protein is found in meat, meat products, and dairy products
- Drink enough fluid (1.5-2 litres per 24 hours)
- Limit the consumption of strong black tea, iced tea, chocolate, and chocolate products
This does not mean you can never eat or drinks these products! They just need to be taken in moderation.
Are kidney stones hereditary?
Kidney stones can be hereditary. We know that patients with kidney stones often have relatives who also once had kidney stones.