Definition & Overview
A ureteroscopy is a medical procedure used to examine the upper urinary tract to diagnose certain diseases such as urinary tract infection or even cancer. The procedure makes use of a small tube instrument called an endoscope, which is similar to a flexible telescope. This viewing tube, which has a small camera attached to its end, is inserted into the ureter and bladder. In general, a ureteroscopy is considered as the endoscopy of the upper urinary tract.
Aside from its diagnostic purpose, ureteroscopy can also be used to remove kidney stones that are located in the ureter or kidney itself. The procedure can remove kidney stones of all sizes, but larger ones are typically fragmented first then removed using a helium laser device, high-frequency sound waves, or electrical energy. The procedure is also performed to examine and remove a tumor.
Who should undergo and expected results
Ureteroscopy is recommended for patients who have conditions affecting the urinary tract, such as:
- Kidney stones
- Urinary tract infection (especially when it occurs frequently)
- Abnormal result (or finding an unusual cell) after a urine sample
- Blockage in the urinary tract
- An unusual growth or polyp in the urinary tract
- Tumor in the urinary tract
- Cancer in the urinary tract
A ureteroscopy is also an alternative treatment for those who are not cleared to undergo a procedure called shock wave lithotripsy (SML). An SML is another treatment procedure that is commonly performed to remove stones found in the kidney or the ureter. There are restrictions, however, that may hinder a person from undergoing the procedure; those who are pregnant, has a blood clot problem, and obese are advised against undergoing an SML. Thus, they usually undergo a ureteroscopy instead.
How the procedure works
Ureteroscopy is mainly a diagnostic procedure, but it is also used as a minimally invasive treatment procedure for the removal of kidney stones. When performed for therapeutic purposes, a ureteroscopy pulls out the stones using forceps or a tiny wire basket, both of which are attached to the endoscope. No incisions or cuts are made during the whole process. Kidney stones that are small in size can be removed easily and in one piece. Larger kidney stones, however, are broken into smaller pieces first through high-frequency sound waves or electrical energy (a process called electrohydraulic lithotripsy), but the most commonly used is laser.
Ureteroscopy is also effective in removing stones located in the ureter and those that are closer to the bladder. First, the stone will be pushed back up the kidney, and then it will be broken up into smaller pieces through lithotripsy.
To keep the patient as comfortable as possible, the procedure is performed under either spinal or general anesthesia.
Possible risks and complications
Complications that may occur during a ureteroscopy include:
- Urinary tract infection
- Injury to the ureter
Matlaga B, Lingeman J. Surgical management of upper Urinary tract calculi. In: Wein, AJ, Kavoussi, LR, Novick, AC et al. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders Elsevier 2011:48.
Sagalowsky A, Jarrett T, Flanigan R. Urothelial tumors of the upper urinary tract and ureter. In: Wein, AJ, Kavoussi, LR, Novick, AC et al. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders Elsevier 2011:53.