A patient may require ureteroscopy (look into the ureter) or pyeloscopy (look into the renal pelvis) for a variety of reasons, for example to investigate blood in the urine or dilatation of the kidney. However, these procedures are most commonly used to treat stones in the kidney or ureter. The urologist passes a laser fibre through the ureteroscope and uses it to fragment the stone into smaller pieces. In most cases these fragments can then pass out of the body in the urine. Larger fragments can be extracted using a wire basket passed through the ureteroscope. This approach is particularly useful for smaller stones and allows treatment of stones in the ureter and kidney at the same time.
Patients who require surgery for their stones will often need placement of a ureteric stent. A stent is a long rubber tube is then fed over a wire and released so that it stays in place in the ureter, allowing urine to bypass any postoperative stone fragments or ureteric swelling. When the time comes to remove the stent, all that is required is a quick procedure using a small telescope passed into the bladder under local anaesthetic.
A special type of X-ray called fluoroscopy is used during surgery to confirm the anatomy of the kidney, determine the location of the stone(s) and to ensure that the final stent has been placed correctly.
Before Your Surgery
Certain medications increase the risk of bleeding and need to be stopped prior to surgery. You should tell your surgeon about all prescription medicines, over the counter medicines, vitamins, and herbal supplements that you are taking. Some patients, such as those with artificial heart valves or high blood clotting risk, will need to take blood-thinning injections whilst coming off their tablet medications.
After Your Surgery
- In most cases you will be able to go home on the same day. In some circumstances it may be appropriate to stay in hospital overnight.
- You may experience some burning when urinating, which usually settles down within a couple of days. Often Panadol and Ural are all that is needed.
- You may have some blood in your urine for a couple of days. Drinking well and resting during this time can help.
- You may resume normal activity unless otherwise advised.
- If you have had a stent placed you may experience:
- Urinary urgency and frequency.
- Discomfort around the bladder, kidney, groin or genitals, which may be worse after urination or physical activity.
- Stent irritation, which is the sensation of being aware of the stent immediately after passing urine. This sensation usually passes quickly and medications are rarely required.
Specific Risks and Side Effects
- Inability to access the stone due to anatomical factors.
- Inability to completely clear all of the stone(s) in one sitting. This may be due to such factors as the size of the stone, its location in the urinary tract and its chemical composition.
- Stone migration. The stone may be pushed out of reach of the instruments during the process of fragmentation, and therefore require alternative treatments.
- The stone may have passed by the time of the procedure.
- Other procedures may be needed depending on the size and location of any residual stone fragments.
- Infection in the urine.
- Scarring of the ureter may occur, causing it to narrow and thereby obstruct the flow of urine from the kidney. Such ureteric strictures occur either as a result of inflammation caused by the stone, or as a reaction to surgical treatment. They are seen in less than 5% of cases and in some cases require further surgery.
- Minor injury to the ureter may occur due to passage of the ureteroscope and other instruments. This usually heals after a period of stenting, without long-term problems.
- Major ureteric injury, including complete separation of the ureter from the kidney, is an extremely rare complication. If this occurs an open operation will be required to fix the problem. If the injury is so severe it cannot be repaired then the entire kidney may need to be removed.
- Anaesthetic complications, such as heart attack or stroke.
- Infection, for example of the urinary tract, chest, or other sites.
- Clots forming in the legs (DVT), which may then pass to the lungs.
- Allergic reactions to drugs, antiseptics, or wound dressings.
- The risk of death relates to the patient’s general health and the complexity of the surgery, and may arise due to either anaesthetic or surgical complications.
When to contact your surgeon
- If there is severe pain that cannot be controlled with over the counter painkillers.
- If you develop a fever, or shivers and shakes.
- If you are unable to pass urine.
- If there is blood in the urine that doesn’t clear despite drinking more water.
- If you develop an infection – this can present with temperature, smelly urine, or burning and stinging when passing urine.