Ureteroscopy (URS) in Madurai: Procedure for Kidney Stone Treatment

Ureteroscopy is a procedure used to find and treat problems associated with the urinary tract. This procedure is done by inserting a thin, flexible, lighted instrument called a ureteroscope through the urethra (the tube through which urine leaves the body) and urinary bladder (the sac in the pelvis that stores the urine) up to the ureter (the tube that connects the kidney and bladder). This allows the doctor to look for any kidney stones and other problems with the urinary tract, which are then treated.

The ureteroscope is a thin, long tube with an eyepiece at one end and a light and lens at the other end. It is inserted into the ureter through the urethra and bladder and used to view the kidney stones. If the stone is small in size, a scope can be inserted through the ureteroscope into the ureter to remove the stone. If the stone is too large to be removed in a single piece, a flexible fiber can be inserted through the ureteroscope and a laser beam can be used to break the stone into smaller pieces. These stones can be passed out of the body with urine.

Ureteroscopy is generally needed when you have kidney stones in the ureter. Note that kidney stones form in a kidney, but can move down to the ureter. URS is especially useful for stones that are closest to the bladder, that is, in the lower half of the ureter.

However, ureteroscopy can also be used to evaluate and treat other causes of kidney blockage or blood in the urine. A ureteroscopy may also be recommended to:

• Check for cancer
• Examine or remove a growth or tumor
• Inspect areas of the ureters that have become narrow
• Diagnose persistent urinary tract infections (UTIs)

When it comes to people who are pregnant, obese, or with a blood clotting disorder, ureteroscopy is a good choice. 

However, ureteroscopy may not be recommended for patients with large kidney stones as the active removal of stone fragments may prove to be impractical. It may not be advised for patients with a history of urinary tract reconstruction either, as their anatomy may not allow the passage of a ureteroscope.

Preparation for the procedure begins with a detailed discussion with the doctor about the procedure, its benefits and risks, and your expectations and questions. 

• The doctor will also discuss your medical and surgical history in detail. 
• A physical exam is done along with an X-ray and ultrasound if needed, before the procedure.
• The doctor may ask you to give a urine sample before the procedure to check for infection.
• If you suffer from any urinary tract infection (UTI), it is first treated and then URS is performed.
• You should follow the doctor’s instructions regarding taking medicines before the surgery. This is because the dosage of certain medicines (like blood thinners) needs to be altered before the surgery to reduce the risk of bleeding during the surgery. Discuss this with your doctor in case you are taking any medicines on a routine basis.
• You may be asked not to eat anything a few hours before the procedure. 
• Also, make sure to arrange for someone to drive you back home after the surgery.

• The procedure is done under general anesthesia so that you are asleep throughout the procedure.  
• A ureteroscope is inserted from the tip of the urethra through the urethra and bladder into the ureter or kidney. 
• Once the ureteroscope is in the bladder, a sterile solution is flushed through the scop to fill the bladder, which enables better visualization of the walls of the bladder. 
• The ureteroscope is now guided up into the ureter. It can be moved up to the kidney as well if there’s some concern about the kidney.
• The surgeon may also use X-ray images with a contrast agent in the ureters to be able to clearly see where the stone is located and to rule out other health problems. 
• Once the stone is located, it is pulled out of the ureter directly with a stone basket. If the stone is larger, a laser is used to break it into smaller pieces, which are then extracted using the basket. If a laser is used to break up small kidney stones, the doctor may typically use a Holmium laser.

• After the surgery, the ureteroscope is removed and your bladder is emptied of the saline solution. 
• Ureteroscopy may result in some swelling in the ureter. Sometimes the doctor may insert a stent inside the ureter to help you pass urine more easily after the surgery. Stent is a small tube that is placed in your ureter to hold it open. 
• You also recover from the anesthesia all this while and it may take between 1 to 4 hours. 
• You will be monitored in a recovery room and can go home once you are awake and can urinate.
• Before you go home, the doctor will prescribe some pain relief medication and antibiotics to prevent infection. 
• You will need to drink plenty of water later to flush out the bladder for the next two hours.
• You may notice some blood while peeing in the next 24 hours which is normal, accompanied by mild pain or discomfort in rare cases. This subsides later. 
• You may feel pain in your bladder and a burning sensation when you pee. For this, you may be advised to take a warm bath or place a warm, damp washcloth over the opening of your urethra to ease discomfort.
• You may also feel pain in your side, especially during and right after urination, if a stent was placed in the ureter. 
• Avoid lifting heavy weights and workouts like swimming and running until the doctor clears you to do so. 
• Do not smoke or consume alcohol after the surgery, as they dehydrate the body and slow down healing.
• The pain and discomfort should start resolving in 5 to 7 days. It may take longer if you have a stent in the ureter.

• It helps to remove/break up kidney stones in the ureter which are made of minerals and salts. It helps to relieve pain and other symptoms associated with it.
• This procedure may be used for confirming a diagnosis in those suffering from a tumor, polyp, or abnormal tissue in the urinary tract.
• Ureteroscopy (URS) helps get a clear view of your urinary tract.
• Since it is an outpatient procedure, the patient can go home on the same day when it is done.
• URS can treat even those stones which are not visible on X-ray.
• In this procedure, there are no cuts or incisions made.

The potential complications of ureteroscopy include:

• Bleeding
• Infection
• Stent pain
• Injury to the ureter
• Discomfort while peeing after the procedure
• Complications related to general anesthesia
• Nausea
• Fatigue
• Swelling
• Scar formation

You must report to the doctor immediately on noticing the following signs and symptoms:

• Extreme pain/burning sensation on urination
• Severe pain or blood in urine lasting over 2-3 days 
• High fever (above 38.5°C) or chills, as this could mean you have an infection
• Fluid drainage at the operated site with a foul odor
• Being unable to urinate

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