This is the endoscopic treatment of ureter stones using a mini-scope. Under general anaesthesia, the ureteroscope is passed via the urethra into the bladder and up the ureter. A laser fibre or lithoclast probe is used to break the stone into smaller pieces. These tiny stone pieces will pass out on their own. Sometimes a wire basket is used to fish out the stone pieces. This surgery takes 30 mins on average and can be done as a day case. Occasionally, a double-J (DJ) stent may need to be inserted if there be any injury to the ureter wall or if there is already gross hydronephrosis (swelling) of the kidney due to the impacted stone. The success rate for stones lodged in the lower ureter is near 100%. For stones lodged at the mid to upper ureter, there is a chance they may float up into the kidney beyond the reach of the scope. If this happens, then a DJ stent is inserted and the stone managed by ESWL.
The advantages of this method over ESWL is that even hard stones can be broken and the ureter opening is simultaneously dilated by the scope to facilitate stone passage.
Complications include:
- bloody urine. This should clear in a few days.
- perforation of the ureter. If this happens, urine leak and pain results. A DJ stent will need to be inserted to prevent the urine leak and avoid late stricture.
- stone migration. Because pressurised water is used to gain clear vision of the ureter and stone, the water pressure may push the stone into the kidney and beyond the reach of the ureteroscope. If this happens, a DJ stent is inserted and ESWL is then performed at a later date.
Desired outcomes:
- no ureter injury
- complete stone breakage (100% success rate)