Bilateral ureteroscopy is a minimally invasive procedure to diagnose and treat conditions within both ureters, the tubes that transport urine from the kidneys to the bladder. It is performed during a single operation using a small, flexible instrument called a ureteroscope. This scope allows a surgeon to see inside these narrow tubes and address issues without external incisions, consolidating two potential procedures into one.
Reasons for a Bilateral Ureteroscopy
The most frequent reason for a bilateral ureteroscopy is the presence of kidney stones in both ureters. When stones become lodged in these tubes, they can obstruct urine flow, causing significant pain and potential kidney damage. Addressing both ureters in one session requires only a single administration of anesthesia and allows for one consolidated recovery period.
Other conditions can also necessitate the procedure. A bilateral ureteroscopy can diagnose and treat ureteral strictures, which are narrowed areas in both tubes that impede urine flow. It may also be used to investigate and treat abnormalities, such as growths or tumors identified in both ureters through imaging tests.
The Procedure Explained
The procedure is performed with the patient under general anesthesia. A surgeon inserts the thin, flexible ureteroscope into the urethra, the tube through which urine exits the body. The scope is guided through the bladder and into one ureter, then the other, allowing the surgeon to see the interior lining on a monitor.
If a kidney stone is located, a laser fiber is passed through the ureteroscope. This technique, laser lithotripsy, uses laser energy to break the stone into smaller fragments. These pieces may then be small enough to pass naturally, or the surgeon can use a tiny basket to capture and remove them.
After clearing the ureters, the surgeon often places a soft, plastic tube called a ureteral stent in each one. These temporary stents keep the ureters open to ensure urine drains freely from the kidneys to the bladder. This prevents blockage from post-operative swelling and supports healing.
Post-Procedure Recovery
After surgery, patients are monitored as the anesthesia wears off, and most can go home the same day. Flank or bladder discomfort is common and is managed with prescribed pain medication. Drinking plenty of water is encouraged to help flush out any remaining stone fragments and ease discomfort during urination.
While the stents are in place, it is common to experience urinary frequency, urgency, and a burning sensation. Blood in the urine is also expected and resolves after the stents are removed. Most patients can return to light activities within a few days, but strenuous activity should be avoided. The stents are removed in the doctor’s office about a week later.
Associated Risks
Bilateral ureteroscopy is a safe procedure, but it carries some risks. The most common complication is a urinary tract infection (UTI), which can be prevented with antibiotics. Minor injury to the ureter, such as a scrape or small perforation, is uncommon, and significant bleeding after the procedure is rare.
Stent-related issues can also arise. Some patients may experience significant discomfort, often called “stent pain,” which is more severe than typical post-operative symptoms. In rare cases, a stent may move out of position, a condition known as stent migration.