What is Ureteroscopy (URSL)?

 

Lithotripsy is a non-invasive procedure, i.e., a procedure where skin is not penetrated, used to treat kidney stones that are too large to pass along the urine. Stones are located using fluoroscopy (a type of x-ray 'movie') or ultrasound (sound waves of high frequency). Lithotripsy works by sending focused ultrasonic energy or shock waves directly on the stones. 

Kidney stones may damage the urinary tract and kidney. Lithotripsy breaks stones into smaller pieces. The stones, then, easily pass through the urinary tract. In ureteroscopic lithotripsy, the doctor uses a ureteroscope for performing the procedure.

 

 

What are benefits of Ureteroscopy (URSL)?

 

Prevents Severe infection, including septicaemia (blood poisoning)

Reduces the chances of permanent kidney damage due to renal scarring and kidney damage.

Restores kidney function. 

Prevents the painful passing of urine 

Eliminates the chances of Bladder blockage. 

 

Who needs Ureteroscopy (URSL)?

 

The procedure of ureteroscopic lithotripsy may be performed to treat and solve the following medical conditions:-

1. Urinary tract infection
2. Urine blockage
3. Pain at the time of urination
4. Decrease in frequency of urination
5. Radiating pain in the abdominal region
6. Kidney stones

 

How is Ureteroscopy (URSL) done?

 

1. Once the patient is asleep, a small instrument called a ureteroscope is passed through the urethra and bladder into the ureter (a tube that transfers the urine from the kidney to the bladder).
2. The ureteroscope is advanced until the stones are located. 
3. If the stones are small, they can be removed using a basket device. In this condition, the stones are not broken and removed intact.
4. In some cases, the stone is too big to be removed by a basket instrument.
5. In such conditions, a laser is used and turned on toward stones. This high-intensity laser will break the stones into smaller fragments.
6. After breaking, the size of stones are reduced, and now they can be removed using a basket instrument without any problem.
7. A laser can also break the stones into too many small pieces. After this, the stones can be excreted out along the urinary tract with the passage of urine.
8. In most cases, a ureteral stent (a thin plastic tube that goes from kidney to bladder through the ureter) may be placed after the procedure. It keeps the urinary tract open after surgery.
9. If the stent is not placed, the ureter may collapse or temporarily swollen up or get blocked by residues of stones or blood clots. In addition, it may result in pain in the kidney after the operation.
10. After this, all the types of equipment are removed, and the skin is stitched using a self-dissolving suture.

 

What to expect before ureteroscopic lithotripsy?

 

1. The doctor may order some tests as deemed necessary depending upon the age and medical history of the patient.
2. You will be allowed to talk to an anesthesiologist. You may ask questions regarding the type of anaesthesia and the possible risks, benefits, and complications.
3. The doctor may order tests like:-
   1. EKG(electrocardiogram):  It is a simple and painless procedure that evaluates the electrical activity of the heart.
   2. CBC(complete blood count): In this test, an overall evaluation of blood is done. It is used to detect various disorders like anaemia.
   3. PT/PTT (blood coagulation profile): It is a test that measures the time taken by the blood to clot.
   4. Urinalysis (analysis of urine): The urine of the patient is analysed to find out the presence of essential minerals in it.
4. You may eat a regular diet before midnight. But after that, you are not allowed to eat and drink until the surgery is completed.
5. The doctor may ask you to stop taking some medicines like a blood thinner, aspirin, and ibuprofen.

 

What to expect on the day of ureteroscopic lithotripsy?

 

1. When you reach the hospital, a staff member will help you in the checking-in process. 
2. Always wear comfortable and loose cloth when going for surgery. Loose clothes will be comfortable to wear after the surgery.
3. Leave contact lenses, other wearables, cosmetics, and jewellery at home.
4. A nurse will guide you to the pre-operative area. There you will be asked to change into a surgical gown.
5. The staff will cross check the details about the patient, like date of birth, father's name, and name of procedure he is preparing for.
6. They will then check the vital signs like blood pressure and pulse rate of the patient.
7. Then they will place an intravenous line on the arm, and the patient will be wheeled into the surgery room on a stretcher.

 

What to expect during surgery?

 

1. The whole procedure of ureteroscopic lithotripsy is done under the influence of general anaesthesia. That is why you will not feel any pain or any sensations.
2. An anesthesiologist will inject you with a precise dose of general anaesthesia. After receiving this, you will fall asleep.
3. An intravenous line will be inserted into your arm. It is used to deliver the medicines if required in between the surgery.
4. All the vital signs like blood pressure, pulse rate and heart rate are continuously monitored during the whole surgery.
5. In very few cases, the ureter is too narrow to pass the ureteroscope into it safely.
6. If any stent is placed, it is removed after one or two weeks of surgery.

 

What to expect after surgery?  

 

1. After completing the surgery, you will be taken to a guided room for observation.
2. All the vital signs like blood pressure, pulse, breathing rate, temperature, and heart rate will be observed until it becomes normal.
3. You may resume your regular diet unless your doctor asks you to change your diet.
4.  You will be asked to drink extra fluids. It is done for diluting the urine and reducing the discomfort during the passing of stone pieces.
5. You will be prescribed some painkillers to reduce the pain caused after the surgery doctor may also prescribe some antibiotics after the surgery. It is prescribed to reduce the chance of any further infections.

First follow-up appointment

1. The doctor may schedule a follow-up appointment after one or two weeks of completing the surgery.
2. If a stent is placed during the surgery, it can be removed at the follow-up appointments.
3. The doctor may give you some tips for faster recovery and home care.

 

What are Risks and Complications after Ureteroscopy (URSL)?

 

Consult the doctor immediately if you are experiencing any of the following symptoms after completing ureteroscopic lithotripsy.

1. Persistent fever either with or without chills
2. Feeling of burning sensation at the time of urination
3. Decreased in frequency or urgency of urination
4. Extreme pain in your lower back
5. Heavy bleeding (very uncommon)
6. Haematuria
7. Fever higher than 101 degree F