Ureteroscopy with Laser Lithotripsy is a minimally invasive medical procedure used primarily to treat kidney and ureteral stones. This technique avoids the need for a surgical incision by using the body’s natural urinary passages for access. It combines two advanced technologies: a specialized scope for visualization and a laser for stone fragmentation. The goal of the procedure is to break down stones that are too large to pass naturally or that are causing severe symptoms, allowing the fragments to be removed or easily passed in the urine.
The Purpose and Mechanism of the Procedure
This procedure is typically chosen for stones lodged in the middle or lower portion of the ureter, the tube connecting the kidney to the bladder, or for kidney stones that are resistant to other treatments like Extracorporeal Shock Wave Lithotripsy (ESWL). Stones that have failed to pass spontaneously or those causing persistent pain, bleeding, or infection are strong indications for this approach. The technique is also effective for managing larger stones, sometimes over two centimeters, particularly with the use of a flexible scope.
The procedure is named for its two distinct technological components. Ureteroscopy involves the use of a ureteroscope, which is a thin, flexible tube equipped with a light and a camera. This instrument is carefully guided through the urethra and bladder and then into the ureter and kidney, allowing the surgeon to directly locate the stone on a monitor.
Once the stone is located, laser lithotripsy begins, which is the process of breaking the stone apart using a laser fiber threaded through the working channel of the ureteroscope. The laser, most commonly a Holmium:YAG (Ho:YAG) laser, emits high-energy light pulses directly onto the stone. This energy fragments the stone into fine dust or small pieces that are manageable for removal or passage.
Preparing for the Procedure
Preparation for ureteroscopy involves several specific steps to ensure patient safety. Patients are required to undergo diagnostic imaging, such as a CT scan or X-ray, to confirm the exact number, size, and precise location of the stones. A urine sample is also collected to screen for any active urinary tract infection, which must be treated before the procedure can safely proceed.
In the days leading up to the surgery, patients must consult with their medical team regarding their medication regimen. They are often required to temporarily stop taking blood thinners, such as aspirin or specific non-steroidal anti-inflammatory drugs, to minimize the risk of excessive bleeding. Patients also meet with an anesthesiologist to discuss the administration of general anesthesia, which is typically used for this surgery.
Strict fasting is required in the hours immediately before the procedure, with instructions usually requiring no food or drink after midnight the night before. Arranging for a responsible adult to drive the patient home afterward is also necessary, as the effects of the anesthesia can cause drowsiness and impair judgment for up to 24 hours.
Steps of the Ureteroscopy and Lithotripsy
The procedure begins after the patient is positioned and placed under general anesthesia. The surgeon inserts the narrow ureteroscope through the urethra and advances it into the bladder. Specialized irrigation fluid is used to expand the urinary tract and provide a clear view for the surgeon.
The scope is then guided upward into the ureter until the stone is visualized on a monitor. A fine laser fiber is passed through the working channel of the ureteroscope and brought into direct contact with the stone. The laser energy is precisely activated to break the stone into fine particles, often referred to as “dust,” or small fragments.
Larger fragments are typically retrieved using a specialized tool, such as a tiny wire basket, which is threaded through the scope. The fine stone dust is then flushed out and passed naturally in the urine. To promote post-operative healing and ensure proper drainage, a temporary ureteral stent is often placed at the conclusion of the procedure. This small, flexible tube extends from the kidney down to the bladder, holding the ureter open to prevent swelling or blockage.
Recovery and Post-Procedure Care
Following the procedure, patients are monitored in a recovery area until the immediate effects of the anesthesia wear off and their pain is manageable. Most individuals are able to return home the same day, although arrangements for a ride must be secured due to the lingering effects of the anesthetic. Pain management initially involves prescribed narcotic medication, which can later be transitioned to over-the-counter pain relievers as discomfort lessens.
A few common symptoms are expected during the initial recovery period:
- Blood in the urine (hematuria) for several days or up to a week, especially if a stent was placed.
- A frequent or urgent need to urinate.
- Mild discomfort in the back or flank area, which can be exacerbated during urination due to the presence of the ureteral stent.
Hydration is an important part of post-procedure care. Patients are advised to drink a high volume of fluids, often two to three liters per day, to help flush the urinary system and pass any remaining stone particles. If a stent was placed, a follow-up appointment is required, typically within one to two weeks, for a brief procedure to remove the temporary device. Patients are generally able to resume most normal activities within a few days, but strenuous activity and heavy lifting are usually restricted for about a week to aid healing.