Ureteroscopy is an endoscopic surgical technique primarily used for diagnosing and treating diseases of the urinary system. This method utilizes a flexible or rigid endoscope inserted through the urethra and bladder directly into the ureter and kidney to visualize and treat lesions. Its main applications include removing urinary stones, incising strictures, or performing tissue biopsies.
This minimally invasive procedure offers advantages such as less trauma and faster recovery compared to traditional open surgery. It is commonly used to treat obstructions from the lower to upper urinary tract, especially effective for stones measuring 0.5 to 2 centimeters in diameter.
Ureteroscopes are classified into rigid and flexible types. Rigid ureteroscopes are suitable for the lower ureter to the lower pole of the kidney, while flexible scopes can bend up to 180 degrees, allowing access to various parts of the kidney. During the procedure, laser lithotripsy devices (such as HoLEP or pneumatic ballistic lithotripsy) are used to fragment stones for removal.
The mechanism involves direct visualization of the lesion, using a fluid circulation system to maintain a clear field of view, and performing lithotripsy or incision of strictures through the working channel. The surgery is usually performed under general or spinal anesthesia, lasting approximately 1 to 3 hours, with a hospital stay of 1 to 2 days.
Mainly indicated for ureteral or renal stones, especially when obstruction causes severe pain, infection, or impaired renal function. Suitable for stones larger than 5mm that cannot pass spontaneously or when extracorporeal shock wave lithotripsy (ESWL) is ineffective.
Other indications include ureteral strictures causing urinary obstruction, biopsy of small renal tumors, and diagnosis of urothelial abnormalities. Special cases such as late pregnancy may consider this approach to avoid radiation exposure.
The procedure involves: 1. Disinfection and anesthesia 2. Insertion of the endoscope through the urethra into the urinary tract 3. Imaging-guided localization of stones 4. Laser lithotripsy or stone retrieval 5. Placement of a double-J stent for drainage (if necessary). Postoperative care includes antibiotics and pain relievers as prescribed by the physician.
There is no fixed "dose" concept for treatment, but the physician will adjust laser energy based on stone size (commonly setting HoLEP laser power at 10-30W). Complex cases may require staged procedures, such as removing large stones in multiple sessions.
Possible complications include:
Serious risks include acute kidney injury or worsening ureteral stricture. If postoperative high fever, severe flank pain, or anuria occurs, immediate medical attention is required.
Contraindications include:
Preoperative imaging of the urinary tract and coagulation profile are necessary. Postoperative adherence to antibiotic protocols and regular follow-up with X-ray or ultrasound to confirm stone clearance are recommended.
Compared to extracorporeal shock wave lithotripsy (ESWL), ureteroscopy can immediately remove fragments but has a lower recurrence rate. Compared to percutaneous nephrolithotomy (PCNL), the scope of application differs; the former targets mid to lower ureteral stones, while the latter handles stones deep within the kidney.
Patients on anticoagulants (such as warfarin) need to adjust medication to reduce bleeding risk. Postoperative pain management and antibiotics should be coordinated with other chronic disease medications (e.g., diabetes drugs).
Clinical studies show that ureteroscopy achieves an immediate clearance rate of over 90% for mid to lower ureteral stones, with a success rate of approximately 80-85% for renal stones. Long-term follow-up indicates a recurrence rate below 10% after one year.
Compared to traditional open surgery, this method can reduce hospitalization time by 70% and decrease postoperative pain. Imaging evidence demonstrates that combined laser lithotripsy reduces residual stone rates to below 5%.
Alternative treatments include:
Conservative treatments such as high fluid intake or positional stone expulsion are only suitable for stones smaller than 5mm without obstruction. The physician will choose the most appropriate method based on stone location, size, and patient health status.
What preparations are needed before surgery? Is fasting or stopping certain medications required?
Before ureteroscopy, patients typically need to fast for 6 to 8 hours and stop anticoagulants (such as aspirin) as instructed to reduce bleeding risk. Medical staff will provide detailed personalized preparation steps, including bladder irrigation or antibiotic prophylaxis, which should be confirmed with the medical team in advance.
What common discomforts may occur after surgery? How can they be alleviated?
Postoperative symptoms may include hematuria, lower back soreness, or mild urinary urgency, which are normal. Pain relievers or anti-inflammatory medications will be prescribed to ease discomfort. Drinking plenty of water is recommended to promote waste elimination, and heavy lifting or vigorous activity should be avoided for at least one week. If hematuria persists beyond 48 hours or is accompanied by high fever, medical attention should be sought immediately.
How long does it take to resume normal activities after surgery? What precautions should be taken?
Most patients can be discharged the day after surgery, but full recovery of daily activities usually takes 1 to 2 weeks. It is advisable to avoid strenuous exercise, prolonged standing, or heavy lifting for at least two weeks, and to monitor urination closely. For laser lithotripsy cases, follow the physician’s instructions regarding sexual activity to prevent complications.
What are the advantages and disadvantages of ureteroscopy compared to extracorporeal shock wave lithotripsy?
Ureteroscopy can directly remove larger or specially located stones, with a low complication rate and high clearance efficiency, but requires anesthesia and invasive operation. ESWL is non-invasive but suitable for smaller stones. The physician will choose the most appropriate treatment based on stone size, location, and patient health; complex cases may involve combined approaches.
What are the approximate success and recurrence rates? How can recurrence be minimized?
The success rate of ureteroscopic stone removal exceeds 90%, but recurrence depends on underlying causes. Patients should undergo regular urine and imaging examinations, adjust diet (such as increasing fluid intake and reducing high-calcium or high-purine foods), and control underlying conditions (e.g., metabolic abnormalities). Following personalized prevention plans can effectively reduce the risk of stone formation recurrence.
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