Ureteroscopy
Figure 1: Ureteroscopy.
What are the indications for a Ureteroscopy?
Indications for Ureteroscopy include:
Treatment of stones in the ureter or kidney
Investigation of abnormal areas or blockages in the ureter or kidney
Diagnosis and treatment of tumours of the ureter or kidney
Surveillance after previous treatment of cancers of lining bladder, ureter or kidney
What pre-operative work up is needed?
Your urologist will organise any necessary urine and blood tests and imaging scans at your consultation prior to your procedure.
If you take any blood thinning medication, you should discuss with your urologist if these need to be stopped before your procedure. In general, aspirin can be continued in most cases but other medications such warfarin, plavix (clopidogrel) and anticoagulants may need to be stopped temporarily.
Please ensure you return any admission forms given to you to be filled out back to the hospital.
What happens on the day of the procedure?
You will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). You should bring a list of your medications, any recent scans or reports with you to the hospital. After you are admitted from the admission lounge, your urologist will see you to discuss the surgery. An anaesthetist will see you to discuss the general anaesthetic before you are taken to the operation theatre. You may be provided with a pair of TED stockings to wear to prevent blood clots from developing and passing into your lungs.
What does this procedure involve?
After a general anaesthetic and an injection of antibiotics, a telescope is passed into your bladder, through your urethra (waterpipe). Using the telescope, a guidewire is passed up into your kidney, using X-ray control. The ureteroscope (semi-rigid or flexible) is then passed up the full length of your ureter into the kidney. A biopsy can be taken using a tiny forceps or a basket passed through the telescope. Any abnormality can be treated using a laser (normally used to break kidney stones) to destroy it. A temporary drainage tube called a stent is left in your ureter to allow passage of blood and debris out of the system.
Occasionally, a “second-look” ureteroscopy may be performed at a later date if we fail to reach the kidney at the initial procedure or if the abnormality is not completely treated. If this is the case, a stent will be left in your ureter until the second procedure.
Most patients will be able to go home on the same day as their procedure or after an overnight stay for monitoring. If you stay overnight, a catheter tube may be left in your bladder overnight.
Are there any risks or side-effects of a ureteroscopy?
Mild burning on passing urine for a few days 50-100%
Blood in the urine for a few days after the procedure 30-40%
Failed access to ureter / kidney requiring second procedure 5%
Infection of the kidney / bladder requiring antibiotic treatment 2-5%
Damage to the ureter requiring stent or nephrostomy insertion / open repair 1-2%
Urethral or ureteric stricture (scar tissue formation in waterpipe or ureter) 1-2%
Major anaesthetic or cardiovascular problems - rare
What can I expect after discharge when I get home?
You should drink twice as much fluid as you would normally for the first 24 to 48 hours, to flush any blood and debris out of your system and reduce the risk of infection.
Most people recover from ureteroscopy quickly; you may return to work and driving after 3-5 days when you are comfortable enough and when your GP is satisfied with your progress. If you have had a stent put in, you may get blood stained urine, pain in your kidney area when you pass urine, or in your bladder; this usually settles quickly but may persist until the stent is removed in some patients.
If you feel unwell, develop a fever, get severe pain in the area of the affected kidney or on passing urine, get severe bleeding with clots in your urine or are unable to pass urine, you should go to your nearest emergency department.
What follow-up will I need?
Your urologist will generally see you in the clinic in the next 4-8 weeks with an X-ray or alternatively as discussed with you prior to the procedure.