What Is a Flexible Ureteroscopy?
It is an endoscopic procedure performed through the ureter and the bladder (natural pathways). This procedure involves the introduction of a flexible device, called flexible ureteroscope, into the ureter and in the renal pelvis. This 3 mm diameter optical instrument is connected to a light source, to a sterile water irrigation tubing and to a camera. It also contains a working channel through which various instruments are introduced, such as guide wires, laser fibers and basket probes.
The manipulation of these instruments is done under direct vision and by fluoroscopic guidance (X-rays).
Why This Intervention?
Ureteroscopy is performed at the urinary stone highly located in the ureter or in the pelvis. An alternative procedure, the extracorporeal lithotripsy, is also possible. Ureteroscopy can be a second attempt to intervene if there is failure in this first alternative. It can also be used in a cancer diagnostic framework or in the treatment of ureteral anomalies such as strictures (the narrowing of channels or vessels). The intervention aims to fragment the calculation by a laser fiber. The fragments are either left in place or they can be removed by a ureteric basket probe.
What to Do Before the Surgery
Routine preoperative tests are required, including a urinal analysis.
To prevent an infection, you will also receive a dose of antibiotics at the beginning of the intervention.
What Happens During the Procedure?
The procedure is achieved in one day by surgery.
Ureteroscopy is performed under spinal or general anesthesia. The patient is placed in lithotomy or in a gynecological position.
Under direct vision, a rigid cystoscope is inserted into the ureter at the level of the bladder. The ureteral orifice is identified and is cannulated with a catheter to first introduce a metallic safety guide at the level of the renal pelvis and of the cavities. A second working guide is then introduced using a dual lumen catheter.
A ureteral UROPASS access sheath is usually introduced at the level of the urinary stone. The ureteroscope is easily introduced inside the catheter up to the urinary stone, and a laser fiber is then inserted into the working channel of the ureteroscope. The urinary stone is gradually fragmented under direct vision. A controlled irrigation under pressure is needed to ensure appropriate visibility. If the visibility is compromised by bleeding, the surgery will be discontinued. It is also possible that the fragmentation of the urinary stone is incomplete. A second session or other alternatives, such as an extracorporeal lithotripsy, may be proposed in the following weeks of the surgery.
Usually at the end of the procedure, it is necessary to leave a double J stent in the urinary tract, to prevent calculus-unrelated swelling and obstruction that lead to flank pain of the renal colic kind. The double J stent may be left in place for a few days up to few weeks after the procedure.
What Are the Usual Postoperative Recommendations?
It is suggested to drink a lot of fluids to help the expulsion of residual fragments and to clarify the urine in the presence of hematuria. An analgesic is also prescribed to relieve the double J postoperative discomforts.
What Are the Postoperative Follow-ups?
An appointment and abdominal radiographies are generally expected in the following weeks of the surgery.
What Are the Possible Risks and Complications?
Risks and complications are very rare (1-2 % of cases). If any situations arise, such as bleeding, the narrowing of the ureters and the ureter perforations, these complications are usually easy to treat with a double J stent for an extended period.
The most common difficulty (10 %) consists of the failure of the surgery’s progression in the ureter, caused by a too narrow caliber ureteral. This is why multiple interventions time is always considered in cases where the ureter is not prepared in advance by a double J stent catheter or if the urinary stone to be treated is too large. In order to avoid risk of injury, a double J stent is temporarily installed to allow the ureter to expand on it. It is then necessary to push back the intervention and to continue the intervention a few weeks later.
Double J stents’ discomforts are frequent.
An infection or a sepsis are possible despite a sterile urine and a preoperative antibiotic prophylaxis. They can quickly occur the same day or later.