A flexible ureteroscope is a medical instrument used for procedures within the urinary tract. It is a very thin, tube-like device notable for its flexibility, allowing it to navigate the natural curves of the body. At the tip of this instrument is a miniature camera and a light source, which transmit images to a monitor.
The ureteroscope’s design also includes a hollow working channel that allows the surgeon to pass other small instruments through the scope. These can include laser fibers, biopsy tools, or miniature baskets. The device is engineered for minimally invasive procedures, meaning it is introduced through the urethra without external incisions. Modern versions have an average tip diameter of about 2.7 millimeters and possess active tip deflection, enabling the surgeon to steer it with precision.
Medical Uses for a Flexible Ureteroscope
The most frequent application for a flexible ureteroscope is the management of kidney stones. Once the stone is visualized, a laser fiber can be passed through the working channel to break the stone into smaller pieces. This procedure is known as intracorporeal lithotripsy.
Following the fragmentation of a stone, a small, basket-like device can be used to retrieve the pieces. Alternatively, the laser can be used to turn the stones into a fine dust, which can then be flushed out of the system naturally. This approach is particularly effective for stones that are too large to pass on their own, typically those greater than 7 millimeters in diameter, or for stones located in complex areas of the kidney.
Beyond stone disease, this instrument is for diagnosing and treating other conditions of the upper urinary tract. It enables urologists to perform biopsies on suspicious tissues, such as potential tumors along the lining of the ureter or kidney. The flexible ureteroscope is also used to treat ureteral strictures, which are areas of narrowing in the ureter that can obstruct urine flow.
The Ureteroscopy Procedure
Before the procedure, patients are instructed to fast for several hours. The surgery is performed while the patient is under general or spinal anesthesia, ensuring they are comfortable and still. To begin, the urologist inserts the tip of the flexible ureteroscope into the urethra, the natural opening for urination.
The scope is then advanced through the bladder and into the ureter, the tube that connects the bladder to the kidney. Using the live video feed from the camera at the tip, the surgeon navigates through the winding path of the ureter. A guidewire may be used to help direct the scope, and X-ray imaging, known as fluoroscopy, can provide a real-time map of the urinary tract to ensure precise placement.
Once the scope reaches the target area, whether it is a kidney stone, a tumor, or a stricture, the treatment phase begins. For a biopsy, tiny forceps are passed through the channel to collect a tissue sample. The entire procedure’s duration can vary depending on the complexity, size, and location of the issue being addressed.
Post-Procedure Recovery
After the ureteroscopy is complete, it is common for the urologist to place a temporary ureteral stent. A stent is a thin, flexible plastic tube that is positioned inside the ureter, running from the kidney down to the bladder. Its purpose is to hold the ureter open, preventing it from swelling shut and ensuring that urine can drain freely from the kidney while the area heals. This stent is not visible from the outside and is removed in the urologist’s office a few days or weeks later.
It is normal to experience some mild pain or a burning sensation during urination. Patients may also feel the need to urinate more frequently and may notice a small amount of blood in their urine. These symptoms are temporary and resolve as the urinary tract heals.
Recovery from a flexible ureteroscopy is usually rapid because it is a minimally invasive surgery. Most individuals can return to their normal daily activities within a few days, depending on their urologist’s specific recommendations. The presence of a ureteral stent can cause some discomfort or bladder awareness, but these feelings subside once the stent is removed.