Ureter Endoscopy
Also known as: ureteroscopy
Ureter endoscopy is a minimally invasive procedure used to diagnose and treat kidney stones, tumours, and other conditions affecting the upper urinary tract. This procedure uses a thin, flexible tube to visualise and address issues within the ureters and kidneys.
What is ureter endoscopy?
Ureteroscopy, also known as ureter endoscopy, is a minimally invasive procedure that enables doctors to diagnose and treat conditions affecting the upper urinary tract, including the ureters and kidneys. This approach has become a standard in urologic care due to its effectiveness and safety.
During the procedure, a thin instrument called a ureteroscope, which can be either rigid or flexible, is inserted through the urethra and into the bladder, then into the ureter. The ureteroscope functions like a small telescope, providing clear views of the urinary tract and enabling precise treatment of conditions such as kidney stones, ureteral strictures, and urinary tract tumours.
Thanks to advanced imaging and laser technology, ureteroscopy allows doctors to treat conditions with high precision, avoiding large incisions and reducing recovery time. These benefits make ureter endoscopy a preferred choice for both diagnostic and therapeutic interventions in the urinary tract.
Indications for ureter endoscopy
Ureter endoscopy is frequently performed to diagnose and treat a variety of upper urinary tract conditions. The most common indication is the evaluation and removal of kidney stones that are causing pain, obstruction, or infection. By restoring normal urine flow, the procedure provides relief from symptoms and helps prevent long-term kidney damage.
This procedure is also valuable for patients experiencing haematuria, or blood in the urine, as it enables doctors to investigate potential causes, such as tumours, neoplasms, or anatomical abnormalities in the ureters. Ureteroscopy can be used to detect and treat urothelial cancers and structural irregularities that may block urine flow or cause other urinary issues. It is beneficial for patients who have undergone prior bladder or ureteral reconstruction, as it enables safe and targeted evaluation of delicate areas.
Benefits of ureter endoscopy
One of the key benefits of ureter endoscopy is that it is typically performed as an outpatient procedure, allowing most patients to return home the same day. Because there are no large incisions involved, patients usually experience less pain and recover quicker, compared to those undergoing open surgery.
The procedure also enables the removal of larger or more complex kidney stones, which can be challenging to treat using other methods. Its versatility and low-risk profile make ureteroscopy a preferred method for addressing both routine and complex urinary tract conditions, including cases requiring reconstruction.
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Before the procedure
Initial consultation
Before having a ureteroscopy, you will have an initial consultation with a urologist. During this appointment, the doctor will go over your medical history, including any current medications, allergies, and previous surgeries. To better understand your condition, the doctor may order diagnostic tests such as urine cultures, blood tests, X-rays, or a CT scan. These tests help provide a clear picture of your urinary tract and identify the size, location, and number of kidney stones, as well as any other abnormalities. They also help detect any infection or other potential issues that need to be managed before the procedure.
The urologist will take time to explain the ureteroscopy procedure in detail, including its benefits, possible risks, and what you can expect at each stage – before, during, and after the surgery. If you have specific medical considerations, such as severe obesity or a history of bladder or ureter reconstruction, the doctor may need to adjust the approach to ensure your safety and the best possible outcome.
Pre-procedure instructions
In the days leading up to your procedure, you will receive clear instructions to help you prepare. You will usually be asked to refrain from eating or drinking for a specific period before the procedure, as general anaesthesia will be used. Some medications, especially blood thinners or non-steroidal anti-inflammatory drugs (NSAIDs), may need to be temporarily stopped to reduce the risk of bleeding. If a urinary tract infection is detected during testing, antibiotics may be initiated in advance to ensure your urine is free of bacteria on the day of the procedure. Because the procedure is done under general anaesthesia, it’s important to arrange for someone to accompany you and drive you home afterwards.
During the procedure
Ureteroscopy is done under general anaesthesia, which means you’ll be asleep and won’t feel anything. You’ll lie on your back with your legs raised, a position that allows the doctor to easily access your urinary tract.
After cleaning and preparing the area, the doctor will insert a thin, tube-like camera called a ureteroscope into the bladder and up into the ureter (the tube that carries urine from the kidney to the bladder). The scope may be rigid or flexible, depending on the location and the type of treatment the doctor needs to perform.
A special sleeve, called a ureteral access sheath, might be used to protect the ureter and allow the doctor to pass instruments in and out safely. Sterile saline solution is used during the procedure to keep the area clear and enhance visibility.
If small stones are found in the ureter, they can often be removed using a tiny basket passed through the scope. Larger stones can be broken into smaller pieces using a laser, allowing them to be removed or passed naturally through the urine later.
Modern imaging and laser tools make the procedure highly accurate, enabling the doctor to treat the problem while protecting the surrounding tissue. Patient safety and comfort are top priorities throughout the process.
After the procedure
Immediate recovery
Recovery is usually smooth. Some discomfort or burning when urinating is common at first, often caused by temporary swelling or a ureteral stent (a soft tube that helps urine drain while the ureter heals). You may also notice blood in the urine or pass tiny stone fragments – this is normal and usually clears up in a few days.
Most people can go home the same day once they can urinate and drink fluids comfortably. Drinking plenty of water helps flush out any potential remaining kidney stone fragments and reduces the risk of infection.
At-home care
At home, you may continue to feel the need to urinate more frequently or urgently, and some mild pain or discomfort in your side (flank) is also common, especially if a stent is still in place. These symptoms can usually be managed with simple medications such as paracetamol or ibuprofen. To prevent infection, a short course of antibiotics is often prescribed; it is essential to take the full course as directed.
While complications are rare, it’s essential to monitor your recovery and contact your doctor if you experience a fever, severe pain, heavy bleeding, or if you are unable to urinate. These may be signs of a more serious problem, such as infection or blockage, and may need urgent attention.
Potential risks and complications
Although ureteroscopy is considered a safe procedure, there are some risks to be aware of. These include infection, including a serious condition called urosepsis, which requires immediate medical care. Minor bleeding can occur but is usually short-lived. In rare cases, the ureter may be injured during the procedure, which could lead to a small tear (perforation), narrowing (stricture), or, in very rare situations, a more serious separation of the ureter (avulsion). These complications are uncommon, but if they occur, further treatment may be needed.
Follow-up care
Follow-up care is a key part of the healing process. If a stent was placed during the procedure, it is usually removed within 5 to 14 days, depending on your recovery. A follow-up appointment is generally scheduled about 1-2 weeks after the procedure. During this visit, your doctor will assess your recovery, address any ongoing symptoms, and review imaging tests to ensure that everything is healing correctly. Attending your follow-up visits and following your doctor’s advice will help ensure a smooth recovery and the best possible outcome after ureteroscopy.
Appointment and Treatment Plan
Initial Consultation
You’ll meet with a urologist to discuss symptoms like pain or blood in the urine. Imaging, such as a CT scan or ultrasound, helps confirm whether ureteroscopy is needed.
Pre-Procedure Preparations
Before the procedure, you may need to fast, stop certain medications, and complete lab tests. Arrange a ride home.
Day of the Procedure
Under general anaesthesia, a ureteroscope is inserted through the bladder into the ureter. Stones (if present) can be removed or broken up with a laser. The procedure takes 30–60 minutes.
Immediately after the procedure
You’ll rest briefly in recovery and then go home the same day. Some discomfort, frequent urination, or blood in the urine is normal for a few days.
Early Recovery at Home
Take it easy for 1-2 days. Stay well-hydrated to flush out your system. Mild pain or urinary symptoms should gradually improve.
Follow-Up Visit
You’ll see your urologist 1-2 weeks after the procedure to check recovery and review any test results. Imaging may be repeated if needed.
Full Recovery
Most people return to normal activities within a week. If no stent was placed, recovery is typically faster. Long-term prevention may be discussed if stones are involved.
Experts
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FAQs
Ureteroscopy, also known as ureter endoscopy, is a minimally invasive procedure that utilises a thin telescope to diagnose and treat issues in the upper urinary tract, such as kidney stones and urinary blockages. This technique allows for effective intervention with reduced recovery time.
Ureter endoscopy effectively treats kidney stones, urinary blockages, upper urinary tract tumours, and anatomical abnormalities. It is a valuable tool for addressing these conditions within the urinary system.
To prepare for ureter endoscopy, you should fast for six hours before the procedure, discontinue blood thinners and NSAIDs as instructed by your urologist, and ensure sterile urine through necessary tests and potentially antibiotics if a urinary tract infection is present. Following these guidelines will help ensure a smooth procedure.
The potential risks of ureter endoscopy include infection, excessive bleeding, ureteral perforation, stricture, and avulsion. Although these complications are rare, it is crucial to be vigilant for signs of disease or any unusual symptoms that may occur after the procedure.
During recovery from ureter endoscopy, you can expect discomfort, frequent urination, and potential blood in your urine. It is essential to hydrate, adhere to pain management guidelines, and take any prescribed antibiotics to promote a smooth recovery.
Recovery time after ureteroscopy varies depending on the individual and the complexity of the procedure. Most patients can expect to return to normal activities within a few days to a week. Mild discomfort, frequent urination, and some blood in the urine are common during the initial recovery period. Drinking plenty of water and following your doctor’s at-home care instructions can help speed up recovery. In some cases, the placement of a ureteral stent may cause additional urinary symptoms that persist until the stent is removed, typically within 1 to 2 weeks.
Ureteroscopy is considered a minimally invasive procedure rather than a major surgery. It is typically performed as an outpatient procedure under general anaesthesia, allowing patients to go home the same day. Unlike open surgery, ureteroscopy involves no large incisions, reducing the risk of complications and shortening recovery time. However, in cases involving large stones, scar tissue, or anatomical abnormalities, the procedure may be more complex and require additional interventions.
Pain experienced after ureteroscopy varies among patients. During the procedure, general anaesthesia ensures that patients do not feel pain. After the procedure, some discomfort or pain in the urinary tract is common, especially during urination, due to ureteral swelling or stent placement. This pain is generally manageable with prescribed pain medications or over-the-counter analgesics. Most patients report that the discomfort is mild to moderate and improves steadily within a few days to weeks following the procedure. If pain is severe or persistent, patients should contact their healthcare provider promptly.