Ureteroscopy, Laser Surgery and Stenting for Kidney Stones 

Key Points

  • Ureteroscopy and laser lithotripsy is a minimally invasive treatment of stones without the need for any cuts or incisions

  • The aim of this procedure is to break and fragment stones in the ureter (the tube draining the kidney into the bladder) or in the kidney

  • A ureteroscope (small camera that goes into the ureter and kidney) is used to visualize the stone(s)

  • Stones are usually broken using laser energy from a fine 200-micron laser fiber

  • Ureteroscopy has largely eliminated the need for open surgery for kidney stones, which is a more invasive treatment with prolonged recovery times

  • A temporary stent (soft rubber tube) is placed in the ureter at the end of the procedure

  • Robotic-assisted surgery can be used if the stone is too large to be fragmented with a ureteroscope

 

Male and Female Urological Anatomy

 

Kidney Stones on CT Scan

What happens on the day of the procedure?

Dr. Ashrafi will meet with you and discuss the surgery again to confirm your consent. An anaesthetist will see you to discuss the general anaesthetic and pain management. The nursing team will check your details and perform a safety checklist prior to your surgery.

Details of the procedure

  • We will do a final safety check

  • We will give you an injection of antibiotics before the procedure

  • We put a cystoscope into your bladder through the urethra

  • We will put a guidewire up into your kidney using X-ray control

  • If the ureter is capacious and accepting, a camera ureteroscope is inserted into the urethra and advanced to the level of the stone

  • Laser energy is delivered to the stone using a fine 200-micron laser fiber

  • The stone is broken by a combination of “dusting” and “fragmentation”

  • A temporary stent is inserted into the ureter which achieves the following things:

    • Eliminates severe pain

    • Protects the kidney from damage

    • Allows small stone fragments to pass

    • Passively dilates the ureter to allow easier access of the ureteroscope at a later date

  • A temporary catheter may be placed into the bladder

  • If the stone is large, difficult to visualize or there is significant inflammation, a relook ureteroscopy at a different day may be necessary to completely treat the stone.

Are there any after-effects?

The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not.

  • Mild burning or bleeding on passing urine for a short time after the procedure (almost all patients)

  • Stent “irritation”: a feeling of discomfort, frequency of voiding or urinary urgency (50%)

  • Unable to access the ureter or reach the stone due to a “tight” ureter requiring further surgery at a later date (5-10%)

  • Urinary infection (1-2%)

  • Minor injury to the ureter (1-2%)

  • Narrowing of the ureter (stricture) requiring further treatment (<1%)

  • Significant injury to the ureter (avulsion or large perforation) requiring further surgery (less than 1 in 1000)

More Information

Reliable and up-to-date health information is important for understanding and managing your health. A list of trustworthy and reputable medical websites is provided below. Please click on the links for further useful information on Kidney Stones.