What is a ureteroscopy?
Ureteroscopy is an endoscopic procedure that allows direct exploration of the ureter and the kidney through natural channels. It is performed using a thin, flexible endoscope, called a ureteroscope, introduced through the urethra, then through the bladder and the ureter, up to the kidney.
This minimally invasive technique is used both for diagnostic purposes and for the treatment of various pathologies of the upper urinary tract, in particular urinary stones.
Indications for ureteroscopy
The principal indications for ureteroscopy are:
- The treatment of urinary stones: this is the most frequent indication. The ureteroscope allows the stone to be visualized and fragmented using a Holmium laser.
- The diagnosis and treatment of upper urinary tract tumors (urothelial tumors of the renal pelvis or ureter).
- The exploration of unexplained hematuria (presence of blood in the urine).
- The treatment of certain stenoses (narrowing) of the ureter.
Course of the procedure
Ureteroscopy is performed under general or locoregional anesthesia, in the operating theatre. The duration of the procedure varies from 30 minutes to 1.5 hours, depending on the complexity of the case.
The surgeon introduces the ureteroscope through natural channels, without skin incision. Once at the level of the stone or the lesion to be treated, several actions are possible:
- Fragmentation of the stone by Holmium laser: the laser pulverizes the stone into small fragments that are eliminated naturally or extracted.
- Extraction of fragments: using a small basket called a Dormia basket.
- Biopsy or treatment of a tumor.
At the end of the procedure, a ureteral stent (called a JJ stent or double-J catheter) is often left in place to facilitate the drainage of urine and to allow proper healing of the ureter. This stent is removed a few days to a few weeks later, during a brief consultation under local anesthesia.
Post-operative follow-up
Hospitalization is short: outpatient or with an overnight stay. Resumption of activity is rapid, within a few days.
In the days following the procedure, certain symptoms are common:
- Sensation of burning when urinating.
- Increased frequency of urination.
- Presence of blood in the urine.
- Lumbar pain related to the JJ stent.
These symptoms are transient and disappear after the removal of the JJ stent.
Risks and complications
Ureteroscopy is a safe procedure, but as with any surgical act, complications can occur:
- Urinary infection: prevented by systematic antibiotic prophylaxis.
- Ureteral injury: rare with modern flexible ureteroscopes.
- Discomfort related to the JJ stent: common but transient.
- Failure of the procedure: in case of an inaccessible stone, requiring a second procedure.
Advantages of digital flexible ureteroscopy
Modern digital flexible ureteroscopy offers numerous advantages:
- Image quality: high-definition vision allowing precise treatment.
- Flexibility of the instrument: access to all the cavities of the kidney.
- Minimally invasive: no skin incision.
- Rapid recovery: short hospitalization, quick resumption of activities.
Dr Adam Vardi, urological surgeon in Paris, is a specialist in digital flexible ureteroscopy with Holmium laser, which he performs at Clinique de l’Alma and Clinique Saint-Louis.