Ureteroscopy and Laser Fragmentation of Kidney Stones

Information

What are ureteral stones?

Your two kidneys filter the body’s waste products out through your urine. Sometimes this waste product can accumulate causing crystals to form; these crystals combine to form a kidney stone. Sometimes these stones become lodged in the ureter.

Removal of Stones

An ureteroscope is a very fine telescope that is passed through the urethra and bladder, up the ureter towards the kidneys.

What type of Anaesthetic?

Patients usually have a general anaesthetic for this procedure. Being asleep means you will feel no pain or discomfort during the procedure.

Occasionally a Spinal anaesthetic may be used where the anaesthetist places a needle in the back to cause numbness in the area to be operated on. You will remain awake but feel no pain or discomfort.

The anaesthetist will discuss with you the type of anaesthetic to be used with you before surgery.

What does the surgeon do?

The surgeon passes a telescope (cystoscope) through the urethra to the bladder where a full inspection is performed.

A very fine wire is then passed up the ureter to the bladder, this act as a guide during the surgery. A Retrograde Pyelogram (a contrast x-ray) which localizes the stone precisely.

The cystoscope is then removed and the ureteroscope is then passed up the ureter to visualize the stone. Small stone can usually be pulled out using the stone basket, but larger stones are shattered using a Lithoclast and the fragments are then removed or pass spontaneously.

After the stone is removed it may be necessary to insert a small internal drain called a JJ stent, which easily removed in a few weeks.

Occasionally the stone may not be reached at the initial attempt due to a very narrow ureter, so a JJ stent may be inserted to allow for dilatation of the ureter over 2-3 weeks. Subsequent Ureteroscopy can then be performed with minimal trauma and damage to the ureter.

What to expect after the Operation

You will be monitored for 2-4 hours post-procedure until the anaesthetic wears off.

You will be able to go home the same day or the following morning

If you had a stent inserted this will be removed at a latter date, the surgeon will arrange this with you

J-J Stents are a hollow plastic tube inserted into the urinary tract prior to lithotripsy. It is absolutely mandatory that this stent be removed.

J-J Stents Complications

The J-J stent is a foreign body and may cause irritation and patient discomfort.

Symptoms may include:

Stent colic/flank pain
Difficulty/pain in urinating (dysuria)
Blood in urine (haematuria)

Are there any Complications?

As with any surgical procedure complications may occur.

The major potential problems are:

Post-operative discomfort
Infection
Bleeding from the kidney
Obstruction of ureter with stone fragments
Failure of stone to fragment.
You should contact your doctor if you:-

Pass bright red blood in urine for more than 24 hours
Have fever, shivers, shakes
Severe pain not relieved through Panadeine Forte
Difficulty in passing urine
Persistent nausea and vomiting

Recovery at Home

Your urine

Drink plenty of fluids, about 2-3litres/day
It may take several weeks for stone particles to pass
Your doctor may ask you to strain your urine so as to collect some stone particles for analysis

Medication

You may experience discomfort /bruising where shockwaves entered. This will resolve in a few days. Take Panadeine as per manufactures instructions

Some pain relief medication may cause constipation. To avoid this:

high fibre diet (prunes, bran etc)

you may need a laxative (Senokot)

Activity

go home and rest after discharge

do not drive a car, operate machinery, drink alcohol, exercise or work until the following day

Normal daily activities may be resumed the day following discharge.