Ureteroscopy is a procedure employed by urologists to examine and treat the upper urinary tract, including the ureters and the interior of the kidneys. This minimally invasive technique utilizes a small, specialized viewing instrument to access areas that once required open surgery. Physicians can visually inspect the lining of the urinary system and perform therapeutic interventions without making any external incisions. Ureteroscopy has become a standard method for managing various conditions due to its high success rates and quick recovery period.
Understanding the Ureteroscopy Procedure
Ureteroscopy is performed in a hospital or surgical center, almost always requiring the patient to be under general or spinal anesthesia for comfort and immobilization. The procedure involves the use of a thin, fiber-optic instrument called a ureteroscope, which is carefully inserted through the body’s natural opening, the urethra. The scope then passes through the bladder and continues its path upward into the ureter, the narrow tube connecting the bladder to the kidney.
The type of ureteroscope used depends heavily on the location of the target area. Rigid or semi-rigid scopes are straight and are typically used for problems located in the lower or middle portions of the ureter. Conversely, flexible ureteroscopes feature a steerable tip, allowing the physician to navigate the scope around the tight curves of the ureter and access the kidney’s collecting system, known as the renal pelvis. Pressurized sterile fluid is often irrigated through the scope to gently expand the ureter and improve visualization throughout the entire process.
The Primary Use: Addressing Urinary Stones
The most frequent application of ureteroscopy is the management of stones lodged in the ureter or the kidney (urolithiasis or nephrolithiasis). This method is preferred for stones too large to pass naturally, or for those located in the middle or lower ureter where other treatments, such as shock wave lithotripsy (ESWL), may be less effective. Ureteroscopy offers a direct approach to stone removal, regardless of the stone’s composition, which is an advantage for stones resistant to ESWL (e.g., cystine or uric acid stones).
For smaller stones, the surgeon may use a miniature wire basket, passed through a channel in the ureteroscope, to grasp and remove the stone intact. When the stone is larger, a technique called laser lithotripsy is utilized to break it down. A fine laser fiber is advanced through the scope and delivers energy directly onto the stone’s surface. This energy fragments the stone into tiny pieces, which are then retrieved with the wire basket or are small enough to be passed naturally.
Ureteroscopy is well-suited for treating stones up to 2 centimeters in the kidney and is a reliable option for all sizes of ureteral stones. The procedure provides immediate stone clearance, a significant advantage over methods that rely on the body to pass fragments over time. This technique is also the primary choice for patients who cannot undergo external shock wave therapy, such as those who are pregnant, morbidly obese, or require continuous blood-thinning medication.
Diagnostic and Therapeutic Secondary Uses
Beyond stone management, ureteroscopy serves several other diagnostic and therapeutic purposes within the upper urinary tract. The scope’s high-definition camera allows for the direct visualization of the ureter and kidney lining, which is invaluable when investigating unexplained hematuria (blood in the urine). This direct inspection can often pinpoint a source of bleeding not clearly identified on prior imaging studies.
The procedure is also used to identify and manage tissue abnormalities, such as tumors or suspicious lesions. If a growth is detected, the surgeon can take a biopsy using instruments passed through the scope, collecting a tissue sample for analysis to determine if it is cancerous. For small, low-grade tumors, the laser may be used therapeutically to ablate or vaporize the lesion entirely.
Ureteroscopy is also employed in the treatment of ureteral strictures, which are areas of abnormal narrowing that impede urine flow. The surgeon uses the scope to visualize the stricture and then uses specialized instruments to cut or dilate the narrowed segment, restoring normal urine flow. This allows for targeted intervention with minimal impact on surrounding healthy tissue.
Patient Recovery and Expected Outcomes
Because ureteroscopy is a minimally invasive outpatient procedure, most patients return home the same day. A ureteral stent, a thin, temporary plastic tube, is frequently placed in the ureter at the end of the procedure, extending from the kidney to the bladder. The stent bypasses any immediate swelling caused by the procedure, ensuring the kidney drains urine properly while the tract heals.
It is common for patients to experience side effects while the stent is in place, including a frequent or urgent need to urinate and mild-to-moderate discomfort in the back or lower abdomen. The stent can also cause a burning sensation during urination and may result in mild hematuria (pink or red urine) for a few days. These symptoms are generally managed with prescribed pain medication and increased fluid intake.
Patients are advised to rest for 24 to 48 hours but can usually resume light activities within a few days. The ureteral stent is typically removed in an office visit one to two weeks after the procedure; this is a quick process that does not require anesthesia. Ureteroscopy offers a high rate of success for resolving urinary tract issues with a rapid return to health.