Ureteroscopy

What is ureteroscopy?

A ureteroscope is a long, very thin endoscope with a camera and a working channel. Semi-rigid ureteroscopes are used mainly for stones in the lower ureter; flexible ureteroscopes can bend to reach stones throughout the kidney — a technique sometimes called retrograde intrarenal surgery (RIRS).

Instruments passed through the scope — most often a laser fibre and a small retrieval basket — allow the urologist to fragment and remove stones under direct vision.

What conditions does ureteroscopy treat?

• Kidney stones and stones in the ureter
• Narrowing (stricture) of the ureter, in selected cases
• Investigation of blood in the urine or abnormal imaging of the upper urinary tract
• Diagnosis and, in selected cases, treatment of upper urinary tract tumours

Who may be suitable for ureteroscopy?

Ureteroscopy is a first-line option for most stones in the ureter and for many kidney stones up to about 2 cm, according to AUA and EAU guidance. It may be preferred for people who take blood thinners that cannot be stopped, are significantly overweight, are pregnant (in selected cases), or have stones that are hard or unlikely to respond to shock wave lithotripsy.

An active urinary infection must be treated first. If a blocked kidney is infected, the kidney is first drained with a stent or nephrostomy tube and the stone is treated later.

How is ureteroscopy performed?

1. You are given general or spinal anaesthesia and antibiotics.
2. A cystoscope is used to view the bladder and a fine guidewire is placed up the ureter.
3. The ureteroscope is advanced along the guidewire to the stone. A protective access sheath may be used for kidney stones.
4. The stone is broken into fragments or fine dust with a laser; larger fragments are removed with a basket.
5. A temporary ureteral stent is often placed to keep urine draining while swelling settles.

The procedure usually takes between 30 and 90 minutes, depending on the size and number of stones.

How should I prepare?

• A urine culture is taken beforehand so any infection can be treated
• Tell your doctor about all medicines — particularly blood thinners and diabetes medication — and follow instructions on when to pause them
• Follow fasting instructions for anaesthesia
• Arrange for someone to accompany you home if you are discharged the same day
• If you are travelling, plan to stay in Bangkok until your follow-up review or stent removal is complete

What anaesthesia is used?

Most ureteroscopy is performed under general anaesthesia; spinal anaesthesia is an alternative for some patients. An anaesthesiologist will assess you beforehand and discuss the most suitable approach.

What are the potential benefits?

• No skin incision and a short recovery for most people
• Stones are treated under direct vision, allowing fragments to be removed
• Effective for stones of most compositions, including hard stones
• Can usually be performed while continuing essential blood thinners

What are the risks and complications?

Ureteroscopy is generally safe, but as with any procedure there are risks, which your urologist will discuss with you:

• Stent-related symptoms — urgency, frequency, discomfort in the side when urinating and blood in the urine are common while a stent is in place
• Urinary infection, and rarely sepsis
• Bleeding, usually minor
• Residual fragments that may need further treatment
• Injury to the ureter (uncommon) or later narrowing of the ureter (rare)
• Inability to reach the stone at the first attempt, requiring a stent and a second procedure

What are the alternatives?

Depending on the stone, alternatives include observation with medication, shock wave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) for large kidney stones. See Kidney stone treatment options explained.

What is recovery like?

• Many people go home the same day or the next morning
• Light activities can usually be resumed within a few days; return to work depends on your job and any stent symptoms
• Some blood in the urine and burning are common for a few days
• Drink plenty of fluids unless advised otherwise

What follow-up is needed?

If a stent was placed, it is removed after an agreed period — often days to a couple of weeks — usually by a brief cystoscopy or, in some cases, by gently pulling an attached string. Imaging confirms that stones have cleared, and stone analysis guides a prevention plan.

Ureteroscopy with Dr. Atip

Kidney stones are among Dr. Atip's clinical interests. He will review your imaging, explain whether ureteroscopy or another approach is most suitable for your stone, and walk you through each step of care at Bumrungrad International Hospital.