Ureteroscopy: Treating Your Stone
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You have elected to have a ureteroscopic (yoo-ree'-tur-oh-skopp'-ik) treatment to remove and/or fragment your stone. Ureteroscopy (yoo-ree'-tur-ah'-skoppee) is a common procedure whereby a stone can be removed via a special telescope, or in certain instances, a laser can be used to break the stone up into very small bits that can be passed. Ureteroscopy is done under anesthesia in the operating room. It takes between 30 minutes and 2 hours depending on the stone and your anatomy, and can be very simple or quite complex.
Ureteroscopy requires you to be anesthetized and then put in the "lithotomy" position with your legs in stirrups. You will be asleep before this happens. The procedure first requires the doctor to look inside your bladder and to put in a special guide wire to allow the ureter to be entered. X-rays may be done prior to the actual procedure to locate the stone, and the procedure is done with the aid of real-time x-ray (called fluoroscopy). Depending on the location of the stone, either a shorter semi-rigid scope, or a longer flexible ureteroscope is then inserted into the ureter until the stone is located. The insertion of the scope is usually easy, but occasionally may be difficult. Occasionally the ureter must be dilated with a special balloon to allow the scope to be inserted. After the stone is identified it can be grasped with a basket or grasping instrument and removed intact, or if the stone is too high in the ureter, or embedded, a laser may be used to fragment the stone. The stone fragments are typically left to pass on their own. If the stone is removed whole, then the stone will be sent to the laboratory for analysis.
After the procedure, a small plastic/silicone tube called a stent may be placed for 5-7 days (or more) to help the ureter heal. Remember, your stent is NOT permanent, and can cause significant problems if it is left in longer than 4-6 months. You will then be awakened and taken to the recovery room. Many patients have ureteroscopy as a day surgery procedure.
The procedure is generally effective, and safe, but there are potential serious complications to know about. Perforation of the ureter can result, and this may require prolonged stenting, nephrostomy tube, or even open surgery. This is rare, but can and does occasionally occur. Occasionally the stone cannot be totally removed, or there is a technical malfunction of the equipment requiring the procedure to be halted, and another mode of treatment initiated later. Safety is the primary concern, and reducing ureteral injury is one of the primary goals. Damage to the ureter even by a well-done uncomplicated ureteroscopy has been known to occur creating a ureteral stricture and potentially loss of kidney function. Follow-up x-rays may be ordered if this is suspected.
After the procedure, pain medication and antibiotics will be prescribed, and then you will generally be sent home. Remember, you just had surgery, and although there are no incisions, it was still significant surgery. Most people note continued pain in their side, and some new pains such as pain over the bladder area from the stent. Some folks notice a pain into the side worsening during urination. This is normal as the stent now allows urine to reflux or regurgitate up to the kidney applying pressure which is sensed as pain. Urgent need to urinate and frequent small voiding amounts is common, and blood will be seen in the urine generally for several weeks after the procedure. If you had laser lithotripsy (laser fragmentation of the stone) you may pass small particles of stone that we would like for you to strain and collect. Remember that just because the stone is now gone or broken up, you still have after-effects in the ureter, and you will not feel "100% better" immediately.
The stent placed during surgery will usually (but not always) have a tether or string attached to make removal easy. Removal is typically done in the doctor's office 5-7 days (or longer) later. This may sound scary, but it is quite quick and only somewhat uncomfortable to most. (Remember different people tolerate pain differently, so some folks find it quite painful while others only troublesome--regardless, it's quite quick and simple to remove.) If there is no tether, the stent will be removed with the aid of a cystoscope and graspers in the office.
Once the stent comes out, most patients experience a recurrence of a fairly significant pain about 2-3 hours after this time. This is unavoidable and has to do with swelling of the ureter. Once you know to expect this, you can pre-medicate yourself with pain medication, plan to take it easy, and perhaps ready a hot bath for yourself to aid this discomfort. This pain usually is fleeting, but is very commonly experienced by patients just after their stent is removed so BE PREPARED!
Follow-up appointments may or may not be arranged after your stone is removed. The follow-up schedule is individualized, and some require follow-up for treatment of other stones while others may be free to follow-up as necessary. A page regarding why stones occur and how to help prevent them can be found at Denton Urology's new Stone Page
A couple of books about stones, their treatment, and causes is found on our bookstore website at:
If you have an emergency, the ER is always available, or if you need to speak with the on-call physician, please dial (940) 387-2241. Dr. Casey can be reached for less urgent questions at Dr. Casey's CV Site.
Thanks, and we hope your experience with ureteroscopy is a good one.
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Site updated 6/12/2005
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