A minimally invasive procedure in which the ureter is reached through the urinary tract to fragment 5-15 mm distal or mid-ureteral stones using laser lithotripsy.
Indication
- Stones 5-15 mm in size in the distal or mid ureter
- Ureteral stones that have not responded to shock-wave therapy (ESWL)
- Stones causing flank pain, blood in the urine or urinary obstruction
- Ureteral stones in patients with a single kidney
- Diagnosis and treatment of ureteral strictures or tumours
- Suspected ureteral or renal tumour identified on imaging
Preparation
- Fast for 6-8 hours before the procedure
- Urinalysis and urine culture to rule out active infection
- Temporary discontinuation of blood-thinning medications with physician approval
- Pre-procedure blood tests, ECG and chest X-ray
- Prophylactic antibiotic given before the procedure
How it's performed
- The patient is placed in the lithotomy position; spinal or general anaesthesia is administered
- A thin, flexible endoscope (ureteroscope) is advanced through the urethra into the bladder
- It is passed through the ureteral orifice up the ureter to visualise the stone or lesion
- Holmium or thulium laser fragments the stone into small pieces or dust
- Small fragments are retrieved with a basket; additional samples may be taken from the kidney when needed
- A protective ureteral DJ stent may be placed at the end of the procedure
Post-procedure
- Most patients are discharged the same day or the next day
- If a DJ stent has been placed, it is removed in the outpatient clinic 1-4 weeks later
- Plenty of fluid intake supports passage of small stone fragments
- Follow-up imaging with ultrasound or CT is performed 1-3 months later
- Dietary and medication recommendations for stone prevention are based on stone analysis
Risks
- Urinary tract infection or, rarely, sepsis
- Ureteral injury or perforation (rare)
- Transient haematuria after the procedure
- Flank pain, urinary frequency or burning related to the DJ stent
- Late ureteral stricture (rare)
FAQ
Is this open surgery?
No. Ureteroscopy is performed entirely through the urinary tract with no skin incision and no scar.
Why is a DJ stent used and when is it removed?
It is placed to reduce ureteral oedema and help small stone fragments pass. It is usually removed in the outpatient clinic 1-4 weeks later.
What is the difference between shock-wave lithotripsy (ESWL) and ureteroscopy?
ESWL fragments the stone with shock waves from outside the body, while ureteroscopy visualises the stone directly and fragments it with laser. Success rates are higher with ureteroscopy for distal and mid-ureteral stones and for hard stones.
Will there be pain after the procedure?
Mild flank pain, burning during urination or stent-related discomfort can occur. These are usually controlled with pain medication.
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