Ureteroscopy with Laser Lithotripsy is a minimally invasive procedure used to treat kidney stones located anywhere in the urinary tract, including the kidney, ureter, and bladder. This technique uses focused laser energy to break down the stones into tiny fragments. Unlike traditional surgery, this method does not require external skin incisions, accessing the stone entirely through the body’s natural urinary passages. The procedure effectively clears stones that are too large to pass on their own or are causing a blockage.
Patient Preparation and Procedure Day
Preparation for this outpatient procedure begins with necessary pre-operative testing. The surgical team requires recent imaging, such as a CT scan or X-ray, to confirm the stone’s size and location, along with blood work and a urine sample to rule out infection. Patients are also instructed to temporarily stop certain medications, particularly blood thinners like aspirin, a few days prior to the procedure to minimize bleeding.
On the day before surgery, patients must follow specific dietary instructions, including a strict fasting period, often starting at midnight, necessary for safe anesthesia administration. Upon arrival, patients check in and meet with the surgical and anesthesia teams. General anesthesia is administered, ensuring the patient is asleep and comfortable for the procedure, which typically lasts between one and three hours.
The Mechanism of Laser Lithotripsy
The procedure begins with the urologist inserting a specialized, thin instrument called a ureteroscope through the urethra and bladder. This scope is guided into the ureter or directly into the kidney, depending on the stone’s location. The scope is equipped with a camera and a light source, allowing the surgeon to visualize the urinary tract and precisely locate the stone on an external monitor.
Once the stone is visualized, a flexible laser fiber is passed through the ureteroscope until its tip contacts the stone. The energy is delivered by a Holmium:YAG laser, which is the standard technology used for this treatment. This laser generates intense, pulsed energy that rapidly heats the stone’s surface, causing it to fragment or be vaporized, a process known as lithotripsy.
Surgeons adjust the laser settings to either break the stone into larger pieces that can be retrieved or to “dust” the stone into very fine particles. These fine particles are small enough to be passed spontaneously in the urine. Larger fragments are typically removed using a small basket device passed through the ureteroscope, ensuring maximal stone clearance.
Post-Procedure Care and Recovery
After the procedure, the patient is moved to recovery and monitored until stable for discharge, which usually occurs the same day. The urologist commonly places a temporary ureteral stent, a thin, hollow tube running from the kidney to the bladder, to ensure proper drainage and allow swelling to subside. The stent prevents the ureter from becoming blocked by swelling or residual stone dust, and it is typically removed a few days to a few weeks later in a separate office procedure.
The stent can cause noticeable symptoms, including bladder discomfort, an increased urge to urinate, and pain in the side or back, especially during urination. Patients should expect to see some blood in their urine for several days following the surgery, which is normal and resolves on its own. Pain management begins with prescription medication and transitions to over-the-counter pain relievers.
Most people can return to light activity within a few days, but strenuous activity, such as heavy lifting or intense exercise, should be avoided for about one week. Maintaining a high fluid intake (around three liters of water daily) is recommended to help flush the urinary tract and aid in passing any remaining stone particles. Patients must contact their healthcare provider immediately if they develop a fever or experience severe pain, as these symptoms could indicate an infection or a blockage.