Ureteroscopy is a method to access the “upper tracts” of the collecting system; the Kidney and Ureter draining it down to the Bladder. This procedure can be used for diagnosis purposes, in order to see what is in the kidney directly, or to sample tissue from the kidney or ureter in cases where there are lesions that are suspicious.
In addition, a laser can be deployed through the ureteroscope in order to treat pathologies in the kidney or ureter.
The ureteroscope itself is a very thin plastic and metal telescope which uses solid elements as well as fiber optics in order to send back video to the eyepiece which the Urologist looks through. Fluid is pumped into the kidney and ureter during this procedure in order to puff out the walls so that they can be examined more thoroughly.
When pathologies such as kidney stones are encountered, the laser may be used to fragment the stone into fine particles that will then more easily pass naturally down and out through the urinary tract. Soft tissue pathologies may be sampled with biopsy devices through the scope, or treated with the laser to burn them away.
At the end of the ureteroscopy procedure, a decision to either leave a ureteric stent or not is made. This is thin, hollow straw-like plastic device which rests between the kidney and bladder to allow urine to drain, and to promote resting and healing of the ureter. Usually a stent is placed when there is a lot of work done in the kidney or ureter, or if there was a fair amount of stretching of the ureteric orifice in the bladder just to get the scope in. Stents are also placed if there are complications such as perforations of the kidney or ureter. The stenting is temporary and removed between 1 week and 6 weeks post ureteroscopy via simple cystoscopy in the office.
With regard to complications of this procedure, bleeding from the kidney or ureter is one, as well as perforation of these structures as well. Burning the ureter by accident with the laser or other forms of energy is also a risk which in turn may lead to stricture formation later on. Infection, strictures, and pain following the procedure are also reported. All of these risks are low, but not zero, and should be considered prior to undertaking this procedure.
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