Ureteroscopy is the use of tiny scopes (the size of spaghetti in diameter) that are passed through the urethra and up the urinary collecting system to identify kidney stones. An even smaller laser fiber is then passed through the working channel of the ureteroscope to break the stone up. Holmium laser (Ho:YAG) is the most common and efficient laser for stone disintegration. The procedure is typically an outpatient procedure.
The ideal stone for ureteroscopy is less than 1.5 cm and located in either the kidney or anywhere in the ureter.
What to Expect From Ureteroscopy
The procedure requires general anesthesia and takes approximately 1.5 hours with subsequent post-operative recovery. A ureteral stent is typically placed during the procedure to prevent post operative flank pain that will mimic kidney stone pain.
You can go home the same day and return to the clinic after 4-7 days for stent removal. The stent will either be removed with a tiny flexible scope passed through the meatus, performed in the clinic office (require a few minutes to perform). Alternatively, the stent is removed by pulling a string attached to the stent.
Post operative pain is variable and oral medications will be given to prior to discharge. Passage of sand-like particles is common as the minuscule stone fragments will pass over the 8 weeks of post-operative recovery. You can usually return to work after the stent is removed.
You will then return to the clinic after 8 weeks. By then, you will need to have completed:
- A 24 hour urine collection. This collection should be done about 4 weeks after the surgery.
- An ultrasound of the kidney 6 weeks after surgery, to ensure the kidney has healed up from the surgery.
Stone free rates depend on stone location. Stones in the distal ureter have 99 percent success rate with stone in the proximal ureter having stone free rates ranging 70-90 percent. Stone free rates for stones located in the kidney itself are approximately 80-90 percent.
Ureteroscopy is a very common and safe outpatient procedure. Nevertheless complications include and but are not limited to infection, ureteral stricture (1 percent), need for percutaneous tube placement (rare), open conversion (very rare). bleeding, need for transfusion (less than 1 percent) and risk of additional procedures to completely remove kidney stones.