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Ureteroscopy (URS)
A. Ureteroscopic stone removal involves telescopic removal/ fragmentation of stone(s) in the ureter or kidney with possible placement of a ureteric catheter or stent between the kidney and the bladder.
This usually includes cystoscopy and X ray screening.
A. External shock wave treatment (ESWL), open surgical removal of stones (Open ureterolithotomy, observation or Medical Expulsive Therapy (MET) to allow spontaneous passage.
URS is used most often when ureteric stones are too large to pass spontaneously, targeted by ESWL.
A. You will usually be admitted a day before or on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and your named nurse. An x-ray may be taken in advance of surgery to confirm the position of your stone(s).
You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
Please be sure to inform your urologist in advance of your surgery if you have any of the following:
A. Normally, a full general anaesthetia or spinal anaethesia will be used and you will be asleep throughout the procedure. You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
A telescope is inserted into the bladder through the water pipe (urethra). Under X ray screening, a flexible guidewire is inserted into the affected ureter up to the kidney. A longer telescope (either rigid or flexible) is then inserted into the ureter and passed up to the kidney. The stone is disintegrated using a mechanical probe or laser and the fragments extracted with special retrieval devices. A ureteric catheter or DJ stent and a bladder catheter may be left in place.
A. On the day after surgery, a further x-ray may or may not be performed to assess stone clearance. If a bladder catheter has been inserted, this is usually removed on the day after surgery. You will be able to go home once you are passing urine normally.
The average hospital stay is 1-2 days.
A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after an urological procedure.
Common (greater than 1 in 10)
Occasional (between 1 in 10 and 1 in 50)
Rare (less than 1 in 50)
A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.
When you get home, you should drink twice as much fluid as you would normally to flush your system through and minimise any bleeding. You should aim to keep your urine permanently colourless to minimise the risk of further stone formation.
You may experience pain in the kidney over the first 24 to 72 hours, due to the swelling caused by insertion of the instrument or by the presence of a stent.
Anti-inflammatory painkillers will help this pain which normally settles after 72 hours.
It will take at least 10 days to recover fully from the operation. You should not expect to return to work within seven days.
Double-J stent: If a DJ-stent was placed during the procedure and was not taken out before your hospital discharge, your doctor will tell you when it needs to be removed. This can take anywhere from several days to a few weeks.
A. If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your urologist immediately. Small stone fragments may also pass down the ureter from the kidney, resulting in renal colic; in this event, you should contact your urologist immediately.
A. Try to drink enough fluids daily (in small quantities) throughout the day to help urine flow and small stone fragments to drain spontaneously.
Eat more vegetables and less meat to have a softer stool—if you do not have to squeeze during the toilet visit, it will help the inner healing process.
Give your body a rest during the first week after the procedure. Be careful lifting heavy objects and doing strenuous exercises
A. When you have:
A. A follow-up appointment will be scheduled with you prior to discharge from the hospital. This appointment might be necessary for:
A. Yes, you will need day-care admission. DJ stent will be removed under short general anesthesia.
A. You can prevent further stone recurrence by implementing changes to your diet and fluid intake. You can find the details in the relevant section on the website.