What is ureteroscopy and why would I need one?

Ureteroscopy may not be the most familiar procedure many of us know of but if you are having a urinary tract problem, it may be a necessary plan of action to treat whatever the concern is.

This procedure is used whenever a person is having issues or problems with their urinary tract often having to do with pain upon urination or possibly kidney stones.  The incidence of urolithiasis or stone disease, is about 12% by age 70 for men and 5-6% for women in the United States.  Using a small scope sort of like a flexible telescope, the procedure involves inserting it into the bladder and ureter to diagnose and treat problems within the urinary tract.  The scope helps a doctor to look for signs of trouble such as kidney or ureter stones.

When should a person get one?

Ureteroscopy can be used in either removing kidney stones or ureteral stones.  Fortunately, most stones pass out of the body without any intervention.  But if you are not so lucky, this is when using ureteroscopy can help out.

The difference between kidney stones and ureteral stones is just like they are named – kidney stones form in the kidneys while ureteral stones are a kidney stone that has left the kidney and has moved into the ureter.  Kidney stones are pebble-like objects made of minerals such as calcium and salts found in urine.  The stones will form in the kidneys but have the capability to move down into the ureter.

The main use of ureteroscopy is to look for stones in the ureter and especially for stones closest to the bladder which is located in the lower half of the ureter.  Ureteral stones can be removed during this procedure by passing a tiny wire basket into the lower ureter through the bladder, grabbing the stone, pulling it free and on out the body. 

When it comes to kidney stones, ureteroscopy can be used as part of shock wave lithotripsy (SWL), a treatment to break up kidney stones.  SWL treatment is particularly helpful for women who are pregnant, people who are morbidly obese, and anyone with a blood clotting disorder.  If the kidney stone(s) are very large, oddly shaped or very hard, then it may require another type of treatment besides ureteroscopy such as percutaneous nephrolithotomy or, in rare cases, open surgery.

A urologist, a doctor who specializes in diseases of the urinary tract, may also use a ureteroscopy if they suspect a polyp, tumor, or abnormal tissue somewhere in the urinary tract.  If any of those are found, ureteroscopy can be used to remove a polyp, tumor or abnormal tissue within the urinary tract.

Another use of a ureteroscopy is if a person has a urine blockage in which it can be helpful in determining the cause. 

How is a ureteroscopy done?

Generally, a ureteroscopy can be performed as an outpatient procedure without an overnight hospital stay.  There is no special preparation one has to do to get ready for the procedure other than emptying the bladder beforehand.

General anesthesia is used for the procedure – once a person is asleep is when the urologist will insert the tip of the uteroscope into the urethra (the tube in which urine passes out of the body).  Once the scope is in the bladder, a sterile solution is released filling the bladder allowing the urologist to see the walls more clearly.  From there, the scope is guided into a ureter and if necessary, it can be guided up into the kidney. 

The whole procedure takes about 30 minutes but if there is a stone to remove or break up or a tissue sample taken for a biopsy, then it could take longer. 

Afterwards, a person will be encouraged to drink plenty of water for the next several hours.  They can also expect to have pain upon urination and some blood in the urine during the 24 hours proceeding the procedure.  Painkillers and an antibiotic are often prescribed to reduce discomfort and infection. 

What are the benefits and risks of ureteroscopy?

There are several benefits of ureteroscopy:

·Helps the doctor have a clear view of the urinary tract

·Effective for removing and breaking up kidney or ureter stones

·Good for removing suspicious-looking tissue

·Can usually be done outpatient

The potential complications can be the following:

·A chance of bleeding or injury to the ureter

·A small chance of infection

·Initially after the procedure urinating can be painful or uncomfortable due to swelling in the ureter