Laser Ureteric Stone Surgery
- Ureteroscopy is the Surgery performed to remove stones from the urinary pipe of the Kidney known as the Ureter.
- No Cut, No Scars and No Bleeding
- Can be performed as a Daycare Surgery with same day discharge
- Usually finishes in 30 minutes or less
What is URSL
Ureterorenoscopy is a endoscopic procedure to remove ureteric stones. In this procedure, a endoscope is passed through the urinary passage until it reaches upto the stone. The stone is then fragmented with LASER and the pieces are extracted or washed away with fluid. No cutting or incision is involved in this procedure and it usually takes 10-15 minutes.
What is the cause of formation of stones in ureter?
Stones in the Ureter mostly come down from the Kidneys. Due to their large size and presence of natural narrowings in the ureter they get stuck and are unable to move any further down. They subsequently block the flow of urine from the kidneys into the urinary bladder and the urine starts to accumulate in the kidney and cause pain and kidney damage.
How are stones in the ureter treated?
Small stones (those less than 6-7mm in size) are treated with a combination of medicines which are commonly referred to as Medical Expulsive Therapy. These medicines dissolve the stone layers and widen the urinary pipe by relaxing its muscles and reducing the swelling around the stone. They can be given for two weeks to allow the stone to pass on its own.
If the stone does not pass with medicines in a reasonable period of time then it needs to be removed surgically. Stones in the upper ureter can be treated with any of the above modalities:
Lithotripsy – Technique to Break stones from outside using sound waves. Read More
Mini PCNL – Technique to Push the stone into the kidney and remove it from the Kidney through a 4-6 mm cut. Read More
URSL – Technique of removing the stone endoscopically through the urinary pipe
Stoned in the mid and lower ureter are best removed with Ureteroscopy (URSL)
What if the stone is not removed in time ?
If the stones are not removed in time they tend to get embedded into the lining of the ureter. We call this phenomenon IMPACTION. Impacted stones can cause complete blockage of the urinary pipe and cause permanent damage and even complete loss of the function of the kidney.
Preparing yourself for the Surgery
- If your stone is not coming down on its own Dr. Raman will recommend ureteroscopy to break the stone and remove/clear the stone. To prepare for this surgery you must take the following steps:
- Stop any blood thinners or antiplatelet drugs like aspirin/clopidogril atleast 5-7 days prior to the procedure
- Shave the pubic hair 3 days prior to the procedure or trim the hair on the day of the procedure
- Take a shower on the day of the procedure and wear clean clothes
- Make sure that you empty your bowel on the day of the procedure or a night prior
- Ensure that you are fasting for atleast 8 Hours prior to your scheduled time of surgery. If the Surgery is in the morning then you should not eat or drink anything after dinner (except your recommended medication with sips of water). If the surgery is scheduled in the afternoon then you may have your breakfast by 8 am.
Once you are in the hospital you will be asked to fill the admission request form and sign a consent that informs you about the risks and benefits of the procedure. An Intravenous line will be established and fluids will be started. You will be shifted to the operating suite 10 minutes prior to the scheduled procedure.
Details of URSL
During the procedure a small needle is placed in the back to give an anesthetic injection. After the injection the lower half of the body below the navel will become numb. A small endoscope will be passed through the passage of urine into the ureter and the stone will be broken into small pieces and removed. A stent will be placed if needed. Once the procedure is complete you will be observed in the post operative room and shifted to the Patient room once the sensations have returned.
Is a stent necessary ?
The stent is placed in cases where there is a lot of swelling, ureteric injury or lot of residual stone particles,In procedures that take more than 15 minutes or in case of long standing stones the stent is usually placed, however Dr. Raman would like to place a stent if he feels the clinical need to avoid further complications and renal damage. In any case stent definitely has an advantage if it is put as the kidney and the ureter heal better in its presence.
Post operative course
After you have been shifted to the room you will be instructed not to raise your head for the next 24 hours. You will be allowed liquid diet 6 hours after the surgery. Initially you will have to take sips of water but once you are able to tolerate that you can take clear liquids like coconut water. Subsequently you will be allowed to take soft diet. The foleys catheter which is the urinary pipe, will be removed in the morning following the surgery and once you are able to pass urine on your own you will be discharged on oral medicines.
If the stent has been placed, you can get it removed anytime between one to 3 weeks. During this time your stone analysis report will also be reviewed by Dr. Raman and precise dietary restrictions will be explained to you at the time of your follow up visit or daycare admission for Stent Removal.
What at the possible complications of URSL
- Routine problems include
- High Fever that is not controllable by anti-pyretics
- Continuous Mild Bleeding in urine that lasts more than 24 hours
- burning in urine
- Common complications can be
- urinary sepsis requiring admission and injectable antibiotics
- Persistant frequency and urgency (LUTS)
- leaving behind residual stones
- minor injury to the wall of the ureter
- Rare complications include
- Major injury to the ureter such as disruption from the kidney or the bladder
- Severe bleeding due to need for transfusion and conversion to open surgery
- Injury to the Urethra leading to stricture
- migration of stone through the wall of the ureter