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 to directly access the ureter and kidney, allowing for visual treatment of lesions. Its main applications include removing urinary stones, incising strictures, or performing tissue biopsies.
This minimally invasive procedure offers advantages such as minimal trauma and rapid recovery compared to traditional open surgery. It is commonly used to treat obstructions from the lower to upper urinary tract, especially effective for stones ranging from 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 ureteroscopes can bend up to 180 degrees, allowing access to various parts of the kidney. During treatment, laser lithotripsy devices (such as HoLEP or pneumatic ballistic lithotripsy) are used to fragment stones, which are then extracted.
The mechanism involves direct visualization of the lesion, using a fluid circulation system to maintain a clear view, and performing lithotripsy or incision of strictures through the working channel. The procedure is usually performed under general or spinal anesthesia, lasting approximately 1 to 3 hours, with hospitalization typically lasting 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 pregnant women in mid to late pregnancy may consider this approach to avoid radiation exposure.
The surgical process includes: 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 double-J stent for drainage (if necessary). Postoperative care involves antibiotics and pain relievers as prescribed by the physician.
There is no fixed "dosage" concept for treatment, but the physician adjusts laser energy based on stone size (typically HoLEP laser power set between 10-30W). Complex cases may require staged procedures, such as removing large stones in multiple sessions.
Potential complications include:
Serious risks include acute kidney injury or worsening ureteral stricture. If postoperative high fever, severe flank pain, or anuria occur, immediate medical attention is required.
Contraindications include:
Preoperative imaging of the urinary tract and coagulation function tests are necessary. Postoperative strict adherence to antibiotic guidelines 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 addresses 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 (such as diabetes drugs).
Clinical studies show that ureteroscopy achieves a high 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 1 year).
Compared to traditional open surgery, this method reduces hospitalization time by up to 70% and decreases postoperative pain. Imaging evidence shows that combining laser lithotripsy can reduce 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 select 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 prophylactic antibiotics, which should be confirmed with the healthcare team in advance.
What are common discomforts after surgery? How can they be alleviated?
Postoperative symptoms may include hematuria, lower back soreness, or mild urgency, which are normal. Pain relievers or anti-inflammatory drugs are prescribed to ease discomfort. Drinking plenty of water is recommended to promote waste elimination, and avoiding heavy lifting or vigorous activity for at least one week is advised. If hematuria persists beyond 48 hours or is accompanied by high fever, medical attention should be sought immediately.
How long does it take to recover and resume normal activities? What precautions should be taken?
Most patients can be discharged the next day, but full recovery of daily activities usually takes 1 to 2 weeks. It is recommended to avoid strenuous exercise, prolonged standing, or heavy lifting for at least two weeks, and to monitor urination closely. If laser lithotripsy is performed, follow the physician's instructions to delay sexual activity to prevent complications.
What are the advantages and disadvantages of ureteroscopy compared to ESWL?
Ureteroscopy can directly remove larger or specially located stones, with low complication rates and high clearance rates, 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 reduced?
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 water intake and reducing high-calcium or high-purine foods), and control underlying conditions (such as metabolic abnormalities). Following personalized preventive plans can effectively reduce the risk of stone formation.
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