Why is Ureteroscopy necessary?

Whilst most small kidney stones are able to pass down the pipe which connects the kidney to the bladder (ureter), larger stones tend to get stuck. This results in severe pain, which we call ureteric colic. Most small stones will pass and it is just a question of keeping the patient comfortable until nature takes its course. However larger stones may not pass and in this situation additional treatment is required.

This can take the form of either shock wave treatment (Lithotripsy) or telescopic treatment to remove the stones (Ureteroscopy). Both forms of treatment are effective but in certain situations there are advantages to ureteroscopy. Your urologist has recommended ureteroscopy as the best form of treatment for your stone.

What preparation is needed?

Ureteroscopy is a relatively minor procedure, however as you will be having a general anaesthetic you will be allowed nothing to eat or drink for 4- 6 hours before the procedure.

You will require an x-ray before surgery to check that the stone has not moved. You may also require a chest x-ray or heart tracing if it is felt that this information would be useful for the anaesthetist.

You will come into hospital either the day before surgery or on the morning of surgery.

On the morning of your operation you will change into a hospital gown and will be taken to the operating department on a trolley. The anaesthetist will give you the anaesthetic, usually by an injection in the back of your hand.

How is the operation done?

The first part of the operation is to give you a general anaesthetic so that you will not be aware of anything whilst the operation is being done. The urologist will pass a very fine telescope into the bladder and up the tube connecting the bladder to the kidney (ureter). Once the stone has been identified it will be broken into small pieces and removed. The ureter tube is very narrow and therefore the operating telescope is very fine. The procedure can be fiddly and sometimes it is not possible to remove all the stone fragments on one occasion. The goal is to remove the stone completely.

After the telescope has been inserted, the ureter becomes a little swollen so an internal stent, which is a fine drain leading from the kidney, is placed to help the kidney drain.

What will happen after the operation?

You will wake up in the recovery area in your bed and when the nurses are happy with your condition you will be taken back to the ward. You will have a stent in place, which may be secured to a catheter tube in the bladder. This is a very fine internal drain leading from the kidney.

You will find that on the first few days after surgery there is some discomfort when you pass water. If you have a catheter this will drain into a bag by the side of your bed and will be emptied by the ward staff. The catheter will be removed the day after your operation.

You may also have a drip in a vein in your arm. Depending on your progress and how you are feeling, you may be able to leave hospital on the same day. Most patients spend the night in hospital following surgery and leave the following morning. The urologist may request a further x-ray to ensure that there are no remaining stone fragments. You will receive an outpatient review appointment .If you have a stent you will be given a date to be admitted as a day case for this to be removed.

What problems may occur?

Complications following ureteroscopy are unusual. The most common problem is with urine infection and you will receive antibiotics at the time of the operation in order to prevent this.

In a small percentage of cases it can prove impossible to pass the operating telescope up the ureter, particularly if the ureter is very narrow. In this situation an internal stent may be placed and the procedure repeated after several weeks. There is a small risk of scarring and narrowing of the ureter tube following this procedure.

Is the operation always successful?

The success rate of ureteroscopy depends on the size and location of the stone.  Stones at the bottom end of the ureter are easier to treat and those near the kidney are the most difficult to treat. The aim of treatment is to remove all stone fragments and this is possible in about 75% of cases. If we cannot remove all of the stone fragments at one treatment you may be asked to return for either repeat ureteroscopy or shock wave treatment (lithotripsy).

What can I do to prevent further stones?

The best general advice is to drink plenty of fluids. You should aim to produce at least two litres of urine every day. Your stone will be sent for analysis and depending on your stone, other treatment may be appropriate. If you get recurrent stones, further detailed investigation such as a 24-hour urine collection may be appropriate. The doctors will advise you further.
 

How can other questions be answered?
 
If you are concerned about any aspects of your operation you can make an appointment to see your consultant in the clinic by contacting their secretary (telephone number 0191 233 6161). Alternatively you can speak to staff at the preadmission clinic. Your surgeon will visit you on the ward before surgery to make sure that you understand the treatment. Ask any questions you need to before you sign the consent form.

Finally

Ureteroscopy is a relatively minor procedure. As the instruments are very fine, it can sometimes take a considerable length of time to identify the stone and to complete treatment.