Ureteroscopy

Ureteroscopy is a minimally invasive means of assessing the ureter (the tube transporting urine from the kidney down to the bladder) and is a procedure most commonly done for kidney stones that have come part of the way down this tube, but not quite to the bladder. There are other reasons to do the procedure such as small tumors in the upper urinary system or narrowing of this tube.

The procedure is done under either general or spinal anesthesia and as such the usual pre-anesthesia instructions apply, such as nothing to eat or drink for 8 hours prior to procedure and holding blood thinning medications like aspirin (for 7 days prior to procedure if possible) and coumadin (for 4 days prior to procedure, if possible).

Most patients can go home the same day, but this has to be with someone that can drive you. Occasionally patients will have to stay overnight.

The Procedure

• Depending on the reason for doing the procedure, the operating time can be 30 to 90 minutes in length. A "routine" kidney stone case would be expected to be 30 to 45 minutes in length.
• Oftentimes a stent (small pliable tube) is left in the ureter to act as a conduit through which the urine can pass to bypass any post procedure obstruction. This tube is left indwelling for three days to two weeks afterward per physician discretion. This is entirely contained inside the body and patients can urinate on their own. (This is different from an externally draining urinary catheter that's connected to a bag drainage system.)
• Patients will be in the post-op recovery room for about an hour following the procedure and then either to the step down area where family can be with them or up to an inpatient bed as deemed necessary per physician.
• The amount of discomfort is usually not remarkable. In fact, as most of these patients are stone patients, the discomfort is considerably less. Admittedly the presence of an indwelling stent can be an irritation, but overwhelmingly preferred to the pain of a kidney stone.

Post-Procedure

1. You may have a small nylon thread protruding from the urethra, which is connected to a tube (stent) in the ureter. This is placed to prevent the ureter from spasming and obstructing the passage of urine from that kidney to the bladder leading to "stone-like pain" after the procedure. This thread is used to pull the stent later in the office. You should be able to void and stay dry despite the presence of this. Please take appropriate precautions to avoid accidentally pulling this string.
2. The stent will likely need to stay for one to two weeks, sometimes more and sometimes less, to help keep the ureter open and avoid the obstruction that can cause the back pressure (pain) on the kidney.
3. Expect that there will be some blood in the urine and this may even persist throughout the entirety of the time that the stent is in place.
4. Expect that the stent itself will cause some symptoms like an increased sense of urinary frequency. Many patients will confuse this for a urinary infection, which also causes urinary frequency, but this is not commonly the case. Some patients may even require bladder anti-spasm medications when the sense of urinary frequency is too much of a bother for them.
5. Some patients will also have some discomfort in the region of the kidney at time of urination due to back pressure to the kidney from the bladder pressure being generated. This pressure is transmitted up the stent itself to the kidney causing this phenomenon.
6. Many patients will be able to return to their regular activities within a day or two, although check for any specific instructions on the discharge sheet.
7. If there is a stent in place, its removal in the office is a simple procedure not requiring any anesthesia and most patients will report that it was easier than they had expected.