Ureteroscopy is a diagnostic and therapeutic procedure used to treat kidney stones and ureteral stones. This is performed under a general anaesthetic, usually as a day case.

Key points

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What is Ureteroscopy and Holmium Laser Lithotripsy?

Ureteroscopy with Holmium Laser Lithotripsy is a minimally invasive procedure used to treat kidney stones. This technique involves using a ureteroscope (a small, flexible instrument equipped with a camera), which is passed through the urethra and bladder into the ureter or kidney, where the stone is located. The Holmium Laser is then used to break the kidney stone into smaller pieces that can be passed out of the body or removed directly.

Who is this treatment suitable for?

This procedure is suitable for individuals with kidney stones that are too large to pass on their own, are causing pain, infection, or other complications, and for stones that are lodged in the ureter. It is appropriate for most types of kidney stones, regardless of their composition.

Is this a major operation?

No, ureteroscopy and Holmium Laser Lithotripsy are not considered a major operation. It is a minimally invasive procedure typically performed under general anaesthesia without the need for incisions in the body. Patients can usually return home on the same day of the procedure.

How long does a ureteroscopy procedure take?

A ureteroscopy procedure usually takes 45 minutes to an hour. Patients can go home the same evening.

What to expect during the procedure

How long is recovery from a ureteroscopy?

A ureteroscopy has a fast recovery, and patients can often return to routine activities the next day.

Possible risks and complications

As with any procedure, there are risks involved, though serious complications are rare. These can include:

Ureteroscopy vs Cystoscopy: What’s the difference?

A cystoscopy is a procedure purely to visualise the bladder and is usually the first part of a ureteroscopy, whereas a ureteroscopy is used for visualising the ureter and the kidney and breaking down stones.

Alternative treatments

The best treatment option depends on the stone’s size, type, location, and your overall health.

Extracorporeal Shock Wave Lithotripsy (ESWL)

ESWL is a non-invasive treatment that uses shock waves to break kidney stones into smaller fragments that can be passed through the urine. It’s best suited for stones that are less than 2cm in diameter and located in the kidney or upper ureter. This procedure is performed on an outpatient basis and typically does not require anaesthesia. While ESWL is effective for many patients, it may not work as well for very hard or large stones, and multiple sessions may be required.

Percutaneous Nephrolithotomy (PCNL)

PCNL is a minimally invasive surgical procedure recommended for patients with large or complex kidney stones, or when other treatments have failed. Under general anaesthesia, a small incision is made in the back, and a nephroscope is inserted directly into the kidney to locate and remove the stones. PCNL is highly effective for large stones and offers a quicker resolution compared to other treatments, but it requires hospitalisation and has a longer recovery time.

Frequently asked questions

How effective is this procedure in treating kidney stones?

Ureteroscopy with Holmium Laser Lithotripsy is one of the most effective treatments for kidney stones, boasting a success rate exceeding 90% for stones located both in the ureter and the kidney. Its effectiveness lies in its precision and the ability of the Holmium Laser to fragment stones of any hardness. The direct visualisation of the stone allows for complete fragmentation in most cases, significantly reducing the likelihood of needing a repeat procedure.

Will I experience pain after the procedure?

It’s common to experience some level of discomfort or mild pain after the procedure, particularly during urination. This is usually due to the irritation caused by the ureteroscope passage and the presence of any stent if placed. Pain is generally manageable with over-the-counter pain relievers or prescribed medications. Drinking plenty of water can help minimise discomfort by ensuring a smooth flow of urine.

How soon after the procedure can I return to work?

Your ability to return to work depends on the nature of your job and how you feel. Most patients find they can return to desk-based or non-strenuous work within 1-2 days. However, if your job involves heavy lifting or significant physical activity, you may need to wait a bit longer or modify your work duties temporarily. Always follow your doctor’s specific advice on returning to work and activities.

What are the chances of kidney stones recurring after treatment?

Kidney stone recurrence is influenced by various factors, including dietary habits, fluid intake, genetics, and any underlying medical conditions that may predispose you to stone formation. While the Ureteroscopy and Holmium Laser Lithotripsy procedure effectively removes existing stones, it doesn’t prevent new stones from forming. Your urologist may recommend preventive measures, such as dietary modifications or medications, to reduce the risk of recurrence.

Can the procedure be performed on all types of kidney stones?

Yes, the Holmium Laser is effective in fragmenting all types of kidney stones, regardless of their composition. This includes calcium oxalate, uric acid, struvite, and cystine stones. The versatility of the Holmium Laser makes ureteroscopy a suitable treatment option for nearly all patients suffering from kidney stones, offering a significant advantage over other stone treatment methods that may be less effective on certain stone types.

Is stent placement always necessary?

Stent placement is not always necessary but is quite common following ureteroscopy, especially if there was significant manipulation within the ureter or if there are concerns about swelling leading to blockage after the procedure. The stent helps to ensure the ureter remains open, allowing for the passage of urine and any stone fragments.

Depending on your specific situation, stents are typically removed within a few days to a few weeks after the procedure. While stents can cause some discomfort, including a sensation of urgency or frequency of urination, they play a crucial role in the healing process.

Click here for ureteroscopy patient information from the British Association of Urological Surgeons.