What are the risks and benefits of ureteroscopy?

Ureteroscopy is done to inspect the ureter, which is the tube that drains the bladder to the kidney. This is done using either a rigid or a flexible scope, depending on what the purpose of the procedure is and how far up the ureter the work is done. Most ureteroscopies are done for removing stones from the ureter or kidney. Others are done for diagnostic purposes such as biopsies. Some are done just to monitor a patient with ureteral or bladder cancer. 

Benefits of ureteroscopy are that it is an excellent way to clear ureteral stones and small kidney stones. It allows visual inspection of the ureter and kidney in a way not possible with radiologic procedures. Strictures and other injuries of the ureter can be inspected and in cases where it is needed, biopsies can be done. Laser fibers and stone baskets can be passed through the scopes permitting lithotripsy and stone basket extraction of stones. 

The risks of ureteroscopy are in addition to the risks of cystoscopy. In passing an instrument through the ureteral orifice and into the ureter, this opeing in the bladder can be torn or stretched. The ureter can be torn from the kidney or the bladder, and it can be torn open in the middle. If this happens and the problem is minor, a stent can be left while the ureter heals. Sometimes the injury can be extensive enough that open surgery could be required to repair the ureter. Sometimes the ureter is obstructed by stones or cancer and ureteroscopy fails to open a path for the kidney to drain. In this case a referral to a radiologist that day would be made for placement of a nephrostomy tube to drain the kidney directly. Every surgery has risks of acute or chronic pain, infection and bleeding – this one is no different. Blood may be seen in the urine for a while after ureteroscopy. A stent may need to be placed in the ureter at the end of the procedure, and this can cause discomfort and mild bleeding too. Strictures that narrow the ureter can occur weeks to years after ureteroscopy. 

Risks are managed with careful attention to detail during surgery, and appropriate antibiotics and medications afterwards. The problems of ureteroscopy do not surface often, but it is best to be prepared prior to moving ahead with this procedure. If a thousand procedures are done, some of these complications will occur to a few people because everyone and every situation is slightly different and some procedures are very technically difficult.

Category: Stone Disease

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