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An Overview of Ureteroscopy and Flexible Uretero-Renoscopy

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A special telescope is passed through the urethra, bladder, and into the ureter to the stone or to view the area of interest. The telescope may be rigid or flexible. The procedure is usually performed under general anaesthesia. A stone breaker, grasper or laseris passed up the ureteroscope to perform the procedure. This is a minimally invasive procedure that makes use of natural channels in the body; there are no cuts to the skin. It is a well tolerated and frequently performed procedure.

Ureteroscopy is performed for the following reasons:

  • Stones typically in the distal or middle ureter by rigid ureteroscopy that are unlikely to pass spontaneously or are causing significant discomfort.
  • Stones in the kidney that are not treatable by ESWL
  • To determine the reason for blood in the urine

Advantages of ureteroscopy

  • The stone is usually directly seen allowing the delivery of special instruments or lasers to break the stone. The ureteroscope is passed through natural channels in the body and involve no skin incisions. Providing the stone can be seen, there is a very high chance that the stone will be broken in one session.
  • Flexible ureteroscopy allows entry into all parts of the kidney so that all stones can be removed or vaporised provided they are of an appropriate size and accessible.

Success rates of ureteroscopy – The success rate of ureteroscopy is over 90% for the majority of stones that are treated this way. Success depends

  • Whether there is 1 or more stones present
  • How long the stone has been stuck
  • The location of the stone (where in the kidney or ureter)
  • The size of the stone
  • Whether you have had previous surgery on the kidney
  • The experience of the urologist treating you

Risks factors of ureteroscopy

  • Urine infection: this usually requires antibiotics only
  • Bleeding: this usually settles quickly
  • Damage to the ureter resulting in narrowing of the ureter (‘stricture’) or perforation: this is rare and may require stretching by a balloon and insertion of a JJ stent
  • Failure to break and retrieve the stone: an alternative procedure may be necessary
  • Perforation of the ureter: usually a JJ stent is required for a few weeks after such an injury
  • Detachment (‘avulsion’) of the ureter from kidney: this is very rare and is sometimes unavoidable, but may require open surgery to repair
  • Abdominal or back discomfort
  • Side-effects due to a JJ stent

Difference between rigid and flexible ureteroscopy

Rigid Ureteroscopy Flexible Ureteroscopy
Rigid ureteroscopy is performed literally with a rigid telescope. As such, it look only in a straight line. Flexible ureteroscopy is performed with a very thin and flexible telescope that can perform almost a 180° turn and look back on itself. It is sometimes known as flexible uretero-renoscopy, because it is possible to look into various parts of the inside of the kidney. Using a laser, stones can be vapourised and removed. Flexible uretero-renoscopy tends to be used for stones in the kidney and near the kidney in the upper ureter.
Rigid ureteroscopy is mainly used for stones in the lower and mid ureter closer to the bladder. Flexible ureter-renoscopy is more gentle than rigid ureteroscopy.

Precautions

  • Drink more fluid (especially 2 hours after meals and at night)
  • Adopt a diet appropriate to the type of stone. See calcium stone diet
  • Periodic X-rays or ultrasound to determine if more stones are being formed
  • Follow up in a stone clinic

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