Ureteroscopic Lithotripsy (URSL) : Procedure & Recovery

Overview

Kidney stones are hard substances made up of salts and minerals. As the name suggests, they form within the kidneys but can develop elsewhere in the urinary tract like in the bladder, ureters, or the urethra. The major risk factor for kidney stones is not drinking enough water. 

Certain foods high in oxalates, calcium, and purines can also contribute to stone formation. Genetic predisposition and certain medical disorders such as hyperparathyroidism are also other causes. Intense pain in the back or side, radiating to the lower abdomen and groin, along with symptoms like blood in urine, frequent urination, and nausea, are common indicators of kidney stones.

What Is Ureteroscopic Lithotripsy (URSL)?

URSL, also commonly referred to as ureteroscopic lithotripsy is a modern technique/procedure to treat kidney stones. It is required when the stones are immune to medicines and other non-surgical options.

URSL has a highly successful stone passage rate and causes minimal complications. A precise laser is used to remove the stones stuck in the ureteral passage. Stones ranging from 7-10 mm (small to medium size) can be effectively removed with URSL, giving way to relief from pain and urinary retention. 

Note that ureteroscopic lithotripsy and stent placement go hand in hand. Stent placement is followed by URSL for the easy passage of stone fragments.

When is URSL Indicated?

The decision to use URSL is typically based on factors such as the size, location, and composition of the stones, as well as the patient's overall health. Here are common indications for 

Small to Moderate-Sized Stones:

• URSL is often indicated for stones that are relatively small to moderate in size, typically ranging from a few millimeters to a centimeter.
• Larger stones may be more challenging to treat with URSL and may require alternative procedures.

Ureteral Stones:

• Stones lodged in the ureter, the tube that connects the kidney to the bladder, are often suitable for treatment with URSL.
• The procedure allows for direct visualization and manipulation of stones in the ureter.

Renal Pelvis Stones:

• Stones located in the renal pelvis (the central collecting chamber of the kidney) can be treated using URSL.

Stones Resistant to Other Treatments:

• URSL may be considered when other conservative measures, such as increased fluid intake or medications, have been ineffective in facilitating the passage of stones.

Composition of Stones:

• URSL is effective for stones made of various materials, including calcium oxalate, calcium phosphate, and uric acid.
• The choice of treatment may vary based on the composition of the stones.

Obstruction and Pain:

• URSL may be recommended when kidney or ureteral stones cause significant obstruction, leading to symptoms such as severe pain, hydronephrosis (swelling of the kidney), or impaired kidney function.

It's important for healthcare professionals to carefully assess each case to determine the most appropriate treatment strategy based on the specific characteristics of the stones and the patient's overall health.

How to Prepare For an URSL?

You will have to follow the specific instructions as instructed to enhance the effectiveness of the surgery. Discuss with the doctor about altering the dose of your daily medicines as some (like blood thinners) may be required to be stopped before the procedure to avoid potential complications. Other preparation measures and lifestyle changes include:

• Discussing symptoms, medical history, and the treatment procedure along with its risks in advance with the doctor/urologist.
• Discuss the possibility of an allergic reaction to anesthesia.
• Avoid eating and drinking 6-8 hours prior to the surgery to avoid several complications.
• Stop smoking or using any tobacco products for a brief period before and after the procedure.

What Is The Procedure For Ureteroscopic Lithotripsy (URSL)?

The ureteroscopic lithotripsy procedure is as follows:

• Spinal or general anesthesia, as required, is administered.
• The surgeon inserts a ureteroscope (thin, long fiber-optic scope) into the urethral passage through the urethra. At the same time, an X-ray is also used to see the ureters and kidneys from inside and locate the stone/s.
• The stone is collected in a basket and pulled out of your system.
• Note that if the stone was too large, then the surgeon would use a precision laser to break it into smaller fragments. These pieces then naturally pass out via urine.
• Ureteroscopic lithotripsy and ureteral stent placement are also done together in the procedure. Ureteral stents are generally inserted for flushing out stones. The stent expands the ureteral passage, which allows the stone to easily travel through the ureter, finally moving out of the body.

What To Expect During Recovery After URSL?

The patient is shifted to a recovery room. The healthcare team will monitor your condition until you are stable. You will be discharged the same day if no complications are found. After ureteroscopic laser lithotripsy pain and discomfort are normal. They are a result of stent insertion. Medicines will help manage this pain. You may also notice blood in the urine for about 1-2 weeks. This is normal and will subside gradually.

Recovery and Aftercare Post-URSL Surgery

Whether it is right ureteroscopic lithotripsy or left ureteroscopic lithotripsy, the recovery is short and quick. The following tips can help further with the recovery:

• Eat a healthy diet. Drink plenty of fluids (to flush out stone pieces and blood). Consume a fiber-rich diet. Reduce oxalate-rich foods, animal proteins, and salt (to prevent recurrence). 
• Avoid heavy workouts during the initial days until your doctor instructs.
• Take medicines as prescribed. This will keep up the recovery pace. Certain medicines help manage burning sensations during urination. Pain relievers help manage pain.
• Attend all follow-up sessions. Keep the doctor informed of your progress.
• Contact your doctor immediately in case of abnormal symptoms. 

You can resume your routine within a week of the laser lithotripsy cystoscopy ureteroscopy, and that too, without complications.

What are the Benefits of URSL?

URSL effectively and safely offers you respite from the pain of kidney stones. It is a modern, minimally invasive technique, that involves no cuts/stitches. This keeps things more comfortable for the patient. Other benefits include:

• Less or no bleeding during the surgery
• Minimal complications
• Faster recovery
• Shorter hospital stay
• No scars
• Outpatient procedure
• Resume daily activities within a week

Also called URSL ureteroscopic lithotripsy has benefits over conventional surgeries. Moreover, the success rate of URSL goes further up as the size of the stone goes above 20 mm, and that too, without many complications.

Conclusion

Whether it is left ureteroscopic lithotripsy or right ureteroscopic lithotripsy, or even if it is bilateral lithotripsy, URSL is overall a safe and effective procedure for kidney stone removal with many advantages.

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