- What is Ureteroscopy?
- When is Ureteroscopy performed?
- What preparation is needed for Ureteroscopy?
- How is Ureteroscopy performed?
- How are the results of Ureteroscopy interpreted?
It is an examination helping the Urologist investigate the ureter, i.e. the tubule carrying urine from the kidney to the bladder. The physician uses a very thin and long instrument, called ‘ureteroscope’, to get into the ureter and examine it. There are two types: the semi-rigid ureteroscope and the flexible ureteroscope. Each type has both advantages and disadvantages.
Ureteroscopy can be used as a diagnostic test, when we simply want to investigate the interior of the ureter to confirm some pathological medical condition, or as a therapeutic method to treat the patient's problem.Ureteroscopy is primarily used in case of ureteral stones, strictures or tumors. In most cases, another imaging technique precedes first providing clinical suspicion for the patient's ureteral disease, and then follows ureteroscopy, in order to confirm the diagnosis and -probably- treat the problem.
In most cases, Ureteroscopy is conducted under general anaesthesia. In rare cases, when Ureteroscopy is limited only to the lower ureteral segment, it can be performed with intravenous analgesia and mild sedation. With regard to general anaesthesia, it should be mentioned that, besides the patient’s full anaesthesia, it also provides the advantage of muscle relaxation that significantly facilitates the Urologist to perform the Ureteroscopy more easily and optimally.
Thus, Ureteroscopy requires the same preparation as needed for a small surgical procedure with anaesthesia. The patient has to be NPO (nothing to eat or drink) for 6-8 hours. Also, the patient needs to undergo a simple blood and coagulation test before Ureteroscopy. The therapist physician should always be aware if the patient has any drug allergy, haemorrhagic predisposition or is on anticoagulant therapy. In addition, a urine test before the examination would help exclude the presence of urinary tract infection.
The patient is put under anaesthesia. The Urologist lubricates the patient’s urethra, inserts the ureteroscope into the bladder, passes through the ureteral orifices into the ureter that is to be investigated. According to the disease and type of ureteroscope, the Urologist may use other instruments as well, such as biopsy forceps, stone removal forceps, lithotripsy probes, laser fibers etc. At the end of the procedure, a self-retaining ureteral double-J catheter (DJ) is placed, which remains for a few days.
This diagnostic and therapeutic procedure significantly helps clarify whether a ureteral morphoma is a tumor or not and decide whether a stenosis can be ‘opened up’ or ‘broken’ in order to remove ureteral stones. In difficult cases that cannot be dealt with simpler techniques, it is possible to place a self-retaining ureteral double-J catheter (DJ).
However, given that Ureteroscopy is an invasive procedure, there is the risk for minor to major complications. In every case, there may be anaesthetic adverse events, always depending on the patient’s general health condition. There may occur postoperative fever, mild or severe urinary tract infection, ureteral injury or perforation and, in some cases, the ureteral anatomy may not allow the conduction of the entire examination or the full removal of stones.