Ureteroscopy (URS) Procedure for Stones in Ureter: Hi friends, we have talked about RIRS as modern minimally invasive procedure to remove kidney stones before. Today we will talk about another procedure which helps us to remove stones that are lodged in the ureter. Initially, both the procedures may seem quite similar to you, but please read the article in full as we explain URS procedure in detail and also chalk out the difference between URS and RIRS. Such informative articles are our small efforts to provide as much education about these surgical procedures as possible as it would help you come to a decision.
What is Ureteroscopy (URS) and how is it performed?
Ureteroscopy is a modern minimally invasive procedure which is specially designed to remove stones that are stuck in the Ureter. Ureteroscopy is a fast evolving procedure given the fast improving technology of video imaging, miniature stone baskets, advancing gadgets and instruments combined with the use of highly sophisticated laser technology. We at Institute of Urology, Jaipur use the most advanced Holmium Yag laser to carry out laser procedures.
Now, let me explain the entire procedure in simple words in a step by step manner.
- URS can be performed under spinal anaesthesia or general anaesthesia. Your treating doctor will discuss the options with you prior to surgery.
- Once anaesthesia is administered, our team of anaesthesiologists will be monitoring you closely throughout the procedure.
- A very thin tube with a light source at the tip called as “Ureteroscope” is passed through the urethre (urine pipe). It goes up to the bladder and then up to the ureter. A tiny but powerful camera is attached to this tube, and the doctor can see the pictures on a screen.
- Now, as the tube goes into the ureter and the stone is located, a mini basket captures the stone and it is pulled out through the ureteroscope.
- If the stone is big, or the ureter is very narrow, instead of using a basket to pull out the stone, we can use laser.
- A very thin laser fibre is passed through the ureteroscope and as it reaches the stone, energy of a particular frequency is given which fragments the stone. The stone breaks and it comes out with the help of flushing.
- After the stone is removed, a stent (thin, hollow pipe) is placed in the ureter. Stent helps in the healing of ureter and makes sure the ureter does not narrow down further. The stent is removed after a fortnight.
This was basically how a typical URS is performed. Here are some Frequently asked questions (FAQs) related to URS.
- Que– For how long do I have to stay in the hospital for URS procedure?
Ans– Normally, if the procedure is done in the morning, you can go home by night. However, in some cases, if the patient has other medical conditions such as heart diseases etc, the patient might have to stay in the hospital for 1 day at maximum. - Que– For how long do I have to take medicines after the procedure?
Ans– After the surgery, once the catheter is removed, you will be given some pain medicines and antibiotics. These are usually given for 3-5 days on an average. - Que– After how long can I resume my daily activities after URS procedure?
Ans– You can perform daily activities within the house almost next day. Mostly our patients are able to carry out all their personal activities within 24 hours. You can start driving once pain medicines are stopped. - Que– Do I need to stop any medicines before URS procedure?
Ans– Normally, if you’re on anticoagulants or blood thinners, in low doses they can be continued. However, if you’re on high doses, your treating doctor may give you some specific instructions on how to go about it. Please note, these things are very personalised, so it is of utmost importance that you be 100% transparent about your ongoing medications with your urologist as he will analysie and integrate everything in the best possible way for you. So all you have to do is, be complete honest and discuss all about your medications and symptoms. - Que – Are there any risk or side effects related to the URS procedure?
Ans – The following are risks associated with URS.
i) Blood in Urine: This clears up on its own usually within 2-3 days.
ii) Urinary Tract Infection: This may happen post operatively. Mostly this UTI occurs as the
bacteria gets released from the stone we just broke. In order to avoid this complication,
we put the patient on antibiotic coverage for 3-5 days post surgery.
iii) Ureter Perforation: This is a rare complication. This can be avoided with the help
of modern sophisticated instruments as well as expertise. Nevertheless, if it occurs,
then a stent is placed in the ureter to allow healing and prevent a stricture formation.
iv) Stone Migration: While doing ureteroscopy, there are chances that the stone shifts
its place.
Usually, in this condition, we can still move ahead and remove the stone. But in rare cases,
stone may move up beyond the reach of a ureteroscope.
If you have read our previous articles you may feel this sounds very similar to RIRS. However, the two are different. Let me highlight the main differences below:
- URS uses a semi rigid scope pipe where as the scope pipe used in RIRS is highly flexible.
- URS is less expensive than RIRS, mainly because its instruments are less costly.
- URS can be done in spinal anaesthesia whereas for RIRS we prefer giving general anaesthesia.
Final Notes
So I hope I have given you a fair idea about URS procedure. If you still have any query or doubts, please do not hesitate to call us on 9829013468 or you can directly contact me on 8601539297 through call or whatsapp.
