Ureteroscopy

Ureteroscopy is the internal telescopic examination of the ureter and kidney. It affords the best assessment of stones and disease affecting the lining of the upper urinary tract and may be vital before a urological diagnosis can be reached (diagnostic ureteroscopy). It may be combined with biopsy or simultaneous treatment of strictures, stones or tumours.

Ureteroscopy avoids some of the risks of open surgery and allows for a shorter hospital stay and rapid recovery of normal function. It is performed under general anaesthetic, the telescope being passed into the ureter, via the urethra and bladder. Most patients go home either later on the day of surgery or the following day.

It may be necessary to leave a stent (fine internal plastic tube that sits in the ureter between the kidney and bladder), to drain urine, assist ureteric healing or facilitate later ureteroscopy. A stent may remain in place for up to 3 months – it is vital that it is removed again, as kidney damage may result from a forgotten stent. Stent removal does not require general anaesthesia and can be performed simply as an office-type procedure.

Pre-operatively:

• urine sample to the laboratory 1 week prior to surgery
• repeat X-ray day before, or morning of, surgery
• discontinue aspirin 1 week prior, other medications may need to be stopped
• nil by mouth from midnight

Post-operatively – early:

• day 1: diet, reinstate usual medications, up and about, maintain a high fluid intake (2 litres daily) for 2 weeks
• burning with voiding, frequency and urgency settles rapidly
• many patients experience colicky flank pain for 1-2 days after ureteroscopy, and rarely this may occur intermittently for 2 weeks
• some haematuria (blood in the urine) is expected, occasionally with small clots, and this may also continue for a few days after ureteroscopy. It settles spontaneously with good fluid intake. More significant bleeding is rare.

Although most cases proceed without particular difficulty and have excellent outcomes, surgical complications occur overall in 5% of patients. The ureter may be too narrow to allow the ureteroscope to pass, requiring stenting and delayed ureteroscopy. Stents cause discomfort, particularly with urination, and bleeding, both of which settle partially but incompletely over a few days.

The list below details complications recognised as common or serious, but this does not include the rare and extraordinary.

• Infection may present as burning – frequency – urgency, requiring oral antibiotic treatment; or fevers, sweats and shivers for which admission to hospital for IV antibiotic is needed.
• Patients with underlying bladder obstruction may develop urinary retention requiring catheterisation.
• Ureteric perforation (<2%) usually heals spontaneously and without further problem. Stone fragments may be extruded from the ureter into the adjacent tissues, but these generally do not cause further problems. The procedure may have to be abandoned and a delayed ureteroscopy be necessary; it may be necessary to leave a stent; it may be necessary to drain the kidney by a nephrostomy tube, placed directly through the back into the kidney; the ureter may have to be repaired through an open or laparoscopic operation, which may have to be performed immediately, at the time of the ureteroscopy operation.
• Numbness or tingling, usually temporary
• Death < 0.5%

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.