Ureteroscopy
What is Ureteroscopy?
Ureteroscopy is a minimally invasive procedure used to diagnose and treat conditions affecting the ureters and kidneys. It involves passing a thin, flexible or rigid telescope called a ureteroscope through the urethra, bladder, and into the ureter or kidney without making any external incisions.
The procedure is most commonly performed to remove or break up urinary stones using laser technology, but it can also be used to investigate blood in the urine, treat narrowing of the ureter (strictures), remove small tumours, or obtain tissue samples for biopsy. Ureteroscopy is a well-established treatment that offers excellent outcomes with relatively short recovery times.
What are the Benefits of Ureteroscopy?
Ureteroscopy offers several advantages over more invasive surgical procedures.
Benefits include:
- No external incisions
- Minimally invasive treatment
- Effective removal or treatment of kidney and ureteric stones
- Ability to diagnose abnormalities within the urinary tract
- Short hospital stay, often as a day-case procedure
- Faster recovery compared with open surgery
- High success rates for treating many urinary stones
- Can be combined with laser technology for precise stone fragmentation
When is Ureteroscopy Recommended?
Your urologist may recommend ureteroscopy to investigate or treat a variety of urinary tract conditions.
It is commonly recommended for:
- Kidney or ureteric stones that are unlikely to pass naturally
- Stones that have not responded to lithotripsy
- Persistent blood in the urine requiring investigation
- Narrowing (stricture) of the ureter
- Small tumours within the ureter or kidney
- Removal of retained stone fragments
- Investigation of unexplained urinary tract symptoms
- Collection of biopsy samples from the upper urinary tract
The procedure is suitable for many patients and can often be performed even when other treatment options are less appropriate.
What does Preparation for Ureteroscopy Involve?
Before ureteroscopy, your urologist will perform a full assessment to plan the procedure.
Preparation may include:
- CT scan, ultrasound, or X-ray imaging
- Blood tests and urine tests
- Treatment of any urinary infection before surgery
- Review of medications, particularly blood-thinning medicines
- Fasting instructions before general anaesthesia
- Discussion of the procedure, expected outcomes, and possible need for a temporary ureteric stent
Patients are usually admitted on the day of surgery.
How is Ureteroscopy Performed?
Ureteroscopy is performed under general anaesthetic. The surgeon gently passes the ureteroscope through the natural urinary passage, entering the urethra, bladder, and then advancing into the ureter or kidney under direct vision.
Once the stone or abnormality has been identified, specialised instruments can be passed through the ureteroscope. If treating urinary stones, a laser fibre is commonly used to break the stone into tiny fragments, a technique known as laser lithotripsy. Small fragments may be removed using miniature baskets, while very fine pieces are usually left to pass naturally in the urine.
If a narrowing, tumour, or suspicious area is identified, tissue samples can be taken for laboratory analysis. Depending on the procedure, a temporary ureteric stent may be inserted at the end of surgery to help keep the ureter open, reduce swelling, and allow urine to drain freely while healing occurs. The stent is usually removed after a few days or weeks during a separate outpatient appointment.
What to Expect during Recovery after Ureteroscopy?
Most patients return home on the same day or after an overnight stay.
During the first few days after surgery, it is common to experience:
- Mild burning when passing urine
- Blood in the urine
- Increased urinary frequency or urgency
- Mild discomfort in the side or bladder
- Temporary discomfort if a ureteric stent has been placed
Drinking plenty of fluids helps flush the urinary tract and encourages any remaining stone fragments to pass. Most people return to normal activities within a few days, although strenuous exercise should be avoided until advised by your surgeon.
Follow-up appointments may include imaging studies to confirm successful treatment and removal of any stent if one has been inserted.
What are the Risks and Complications of Ureteroscopy?
Ureteroscopy is considered a safe procedure, but, as with all surgical treatments, complications can occur.
Possible risks include:
- Urinary tract infection
- Bleeding or blood in the urine
- Injury to the ureter
- Temporary discomfort from a ureteric stent
- Difficulty passing stone fragments
- Incomplete stone removal requiring additional treatment
- Narrowing (stricture) of the ureter during healing
- Rare need for further surgery if complications arise
Your urologist will explain the benefits and potential risks of ureteroscopy and recommend the most appropriate treatment based on your individual condition and overall health.