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  • Posted on- Apr 16, 2018
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This is the endoscopic treatment of ureter stones which is performed with the help of using a mini-scope. Under general anesthesia and fluoroscopic x-ray guidance, a rigid or flexible ureteroscope is passed up the ureter via the urethra.

The stone is then broken into smaller pieces with the help of Holmium laser and these tiny stone pieces will pass out on their own.

A wire basket can also be used to trap the stone or extract the broken pieces. This surgery takes 30 minutes on an average and can be done as a day case under general anesthesia.

Occasionally, a double-J (DJ) stent may need to be inserted after the procedure if there is an injury to the ureter wall or if there is prior gross hydronephrosis of the kidney from an impacted stone.

The success rate for stones which gets stuck in the lower ureter is near 100%. For stones lodged at the mid- to the upper ureter, there is a chance they may float up into the kidney.

If the flexible ureteroscope is used in the procedure, this is not an issue as the scope can flex backwards within the kidney calyces to find the stone.

However, if only the rigid ureteroscope is available, then the floated-up stone cannot be treated and a DJ stent is inserted for subsequent ESWL.

The main advantage of URS over ESWL is that even hard stones can be broken and the ureter opening can be dilated to facilitate subsequent stone passage. However, URS is a more expensive and more invasive way of breaking ureter stones.

Complications associated with URS + LL include:

  • Bloody urine - This should clear in a few days.
  • Infection, this occurs post-operatively and is due to bacteria released when the stone is broken. This can be minimized by giving antibiotics prior to the surgery.
  • Perforation of the ureter - If this happens, urine leak and pain results. A DJ stent will need to be inserted to prevent further urine leak and avoid a late stricture
  • Stone migration - Because pressurized water is used to access the ureter and visualize the stone, the pressure may accidentally push the stone up beyond the reach of the ureteroscope.

Desired outcomes from URS + LL :

  • no ureter injury
  • complete stone breakage

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