Kidney Ureteral Stones

FAQ's

FAQ’s

FAQs about URS

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 thebladder 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 a 180° 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 makes 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 ‘calciumoxalate’ 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.

General rules:

  • 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.

FAQs about SWL

When do I need SWL?

Shock-wave lithotripsy (SWL) is often used for stones smaller than 1.5 cm. Treatment is applied to the outside the body (non-invasive). Other options are surgical. Ureteroscopy is used to remove stones smaller than 2 cm from the urinary tract. Percutaneous nephrolithotomy (PCNL) is used for large stones (bigger than 2 cm), very hard stones, or more than one stone. The stone must be in the kidney to use PCNL.

What are the advantages and disadvantages?

Advantages are that SWL is non-invasive and does not require general anaesthesia. SWL is done with a machine that can break kidney stones from outside the body. To break the stone, focused shock waves (short pulses of high energy sound waves) are transmitted to the stone through the skin. The stone absorbs the energy of the shock waves and breaks into smaller pieces. The stonefragments then pass with urine.

If you have a large stone, you may need several sessions to completely break it.

Are there side effects?

You may have blood in your urine, but this should not last more than 2 days. Go back to the hospital if you:

  • Develop a fever
  • Feel pain in your kidney or side
  • Still have blood in your urine more than 2 days after the procedure

How will I know if it worked?

Your doctor will check your symptoms and progress at follow-up. Additional x-rays or CT scan may be used to check that stones have cleared. Depending on the results, your doctor may recommend preventive measures or further tests.

What if the doctor suspects that I have a high risk of forming new stones?

If the results show that you have a high risk of forming more stones, your doctor will do ametabolic evaluation. This is a series of blood and urine tests to determine the possible causes of your stone formation. Depending on the test results, your doctor will recommend preventive measures or further tests. Besides changes in your lifestyle, you may also be advised to take medication that reduces the risk of stones recurring. Generally, the medication will cause few or no side effects.

Changes in your lifestyle

Even if you have a low risk of forming another stone, your doctor and nurse will advise you to make some lifestyle changes.

What can I do to prevent more stones?

The following steps can reduce the chance of having significant stones in the future:

  • Increasing fluid intake to 2.5–3.0 litres per day to neutralize the pH of your urine
  • Adopting a balanced diet, with less meat and alcohol and more vegetables and fibre, to have healthy calcium levels and less animal protein
  • Maintaining a healthy weight (normal body mass index) and adequate physical activity
  • Getting periodic x-rays or ultrasound to determine whether more stones are forming
  • Going to follow-up visits at a stone clinic

FAQs about PCNL

What are the risks of PCNL?

Even minimally invasive surgeries, like percutaneous nephrolithotomy, have risks of infection, bleeding, and other complications. The procedure creates a hole in the kidney that usually heals without other treatment. Operations on the abdomen carry a small risk of injury to other nearby organs, such as the bowel, the ureter, the liver or the bladder.

ls PCNL my only option?

Percutaneous nephrolithotomy (PCNL) should be considered when your stone is very large (bigger than 2 cm) and has not moved to the ureter. Your doctor may also discuss PCNL as a treatment option if:

  • You have more than one stone
  • Your stone is very hard

Other treatment options for stone removal are ureteroscopy (URS) or shock-wave lithotripsy (SWL). URS is used to remove stones smaller than 2 cm. SWL is applied outside the body (non-invasive treatment) and often is reserved for stones smaller than 1.5 cm.

What are the advantages and disadvantages?

An advantage of PCNL is that it is the most effective way to make sure a patient is stone-free. Most patients leave the hospital stone free. Occasionally, though, another procedure will be needed to remove a stone.

Even though PCNL involves an incision, it is less invasive than a full open surgery to treat the kidney stone. Because PCNL is a more difficult surgery, it is performed by surgeons with specialized training. Urologists and radiologists may work together on this surgery.

What if the doctor suspects that I have a high risk of forming new stones?

If the results show that you have a high risk of forming more stones, your doctor will do a metabolic evaluation. This is a series of blood and urine tests to determine the possible causes of your stone formation. Depending on the test results, your doctor will recommend preventive measures or further tests. Besides changes in your lifestyle, you may also be advised to take medication that reduces the risk of stones recurring. Generally, the medication will cause few or no side effects.

Changes in your lifestyle

Even if you have a low risk of forming another stone, your doctor and nurse will advise you to make some lifestyle changes.

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