Ureteroscopy with Laser Lithotripsy

Ureteroscopy with Laser Lithotripsy

Ureteroscopy is a procedure whereby a small telescope is passed through your urethra, bladder and ureter to visualize the inside of your upper urinary tract. No surgical incisions are made on the outside of your body. This procedure is generally performed while you are under a general anesthetic at either a hospital or outpatient surgical center. Ureteroscopy is usually performed to treat stones in your kidney or ureter but it can also be used for other purposes such as the treatment of urinary tract obstructions or tumors.

How are kidney stones removed from my body using ureteroscopy?

A combination of semirigid and/or flexible ureteroscopes are utilized to carefully examine your entire upper urinary tract, both under direct vision and under fluoroscopic (x-ray) guidance. The location of the kidney stone is usually known prior to the procedure based on preoperative imaging studies but they may have moved to a different location by the time you are ready to have your surgery performed. Once the location of stone is determined intraoperatively, Dr. Horovitz will generally treat it using a laser fiber that fits through the ureteroscope. The pieces of fragmented stone are either removed with small, flexible baskets or broken into extremely small pieces that will pass down your ureter and into your bladder naturally.

What types of stones are best treated ureteroscopically?

Ureteroscopy is generally preferred to extracorporeal shockwave lithotripsy (ESWL) for mid to distal ureteral stones. Ureteroscopy is also preferred for certain stone composition types that are particularly resistant to ESWL (ex. cysteine, uric acid) or those that are not visible on x-ray. Most kidney stones ≤ 2cm (or if they are ≤ 1 cm in the lower pole) may be treated with ureteroscopy or ESWL.[1] While ureteroscopy generally has a higher success than ESWL, it comes with a slightly higher intrinsic complication rate albeit both modalities are very safe. Patients with larger or more complicated renal stones should be offered percutaneous nephrolithotomy as first-line treatment in most cases. Other, rarer modalities to treat kidney stones include anatrophic nephrolitholomy, pyelolithotomy with or without pyeloplasty and nephrectomy (if there is minimal or no kidney function). These are all general recommendations and the decision of which treatment modality best suits your particular situation is nuanced so it should be made in conjunction with Dr. Horovitz, taking into account your expectations, individual medical comorbidities, stone size, stone composition, stone burden, prior stone treatments, renal function and any complicating anatomical factors that you may have.

What can I expect after the procedure?

Generally, Dr. Horovitz will leave a temporary, thin plastic tube called a stent in your ureter after the procedure. The stent helps to prevent your ureter from temporary closing off due to post-operative swelling and in doing so, ensures that you have good pain and nausea control during the healing process. Stents are generally well tolerated and, in most cases, are attached to a string that is left dangling outside your urethra. The string allows you to remove the stent yourself by simply pulling it on a date that is best determined by Dr. Horovitz, usually about 5 days post-procedure. In other cases, a string will not be left and Dr. Horovitz will remove the stent in his office at your follow-up appointment using specialized, minimally invasive equipment

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