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Ureteroscopy And/Or Laser Stone Fragmentation/ Or Biopsy

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Ureteroscopy And/Or Laser Stone Fragmentation/ Or Biopsy Ureteroscopy and/or laser stone fragmentation/ or biopsy This leaflet is for patients who are going to have an ureteroscopy and/or laser stone fragmentation or biopsy. It tries to answer any questions you may have about the operation, what will happen when you are in hospital and once you go home. What is the procedure/operation/treatment that I am to have? Ureteroscopy means a telescopic inspection of the ureter, sometimes going up as far as the inside of the kidney. The fine camera is inserted through the urethra (water pipe) and into the bladder to gain access to the ureter (the tube that joins the kidney with the bladder); no cuts are made in the skin. Through the ureteroscopy, the surgeon is able to view the lining of the ureter and kidney and, depending on the reason for doing it, either treat a stone or take a biopsy of an area of abnormality. Why do I need an ureteroscopy? There are two main reasons why an ureteroscopy needs to be performed; your doctor will have discussed this with you. These reasons are:- 1 You have a stone in the ureter or kidney which cannot pass by itself or may be causing problems therefore a ureteroscopy needs to be performed so that this can be treated. A safe way of treating stones in the ureter or kidney is with a laser. 2 You may have had a scan which either suggests an area of abnormality or does not give clear views of the ureter or kidney so a direct look is needed. At this time pictures and a biopsy (tissue sample) may be taken. Benefits of ureteroscopy The main aim is to treat a stone or obtain biopsies in one session. Alternative treatments for stones Extracorporeal Shock Wave Lithotripsy (ESWL) This is an outpatient procedure which involves treating your stone with shock waves; it aims to break up the stone into small enough pieces to pass by themselves. This is only possible if the stones can be seen on X-ray. It may also require more than one treatment to treat the stone. Percutaneous NephroLithotomy (PCNL) This is key-hole surgery to treat stones in the kidney. It is performed under a general anaesthetic and involves a small cut in the side and is successful for large stones in the kidney. As it involves a cut it is more associated with pain afterwards and a tube may need to be placed directly from the kidney out on the side for a short while after the operation. What risks are there? Complications. Any operation has potential risks. You have to discuss the benefits and risks of having the operation with your doctor. Common complications (greater than 10%). Pain: You will feel some discomfort in the back and lower abdomen. This pain will ease with time and you will be given painkillers to help control the pain. Stent: This is a narrow, plastic-like tube, which is put into the ureter to allow the kidney to drain after the operation and prevent any blockage that might be caused by post-operative swelling of the ureter. This is only a temporary measure and is removed within a couple of weeks after the operation under local anaesthetic in outpatients in the urology department. If a stent is placed it is very common to notice symptoms. These include blood in the urine, the feeling of needing to pass urine frequently, back pain, ‘cystitis’-type symptoms. These will settle once the stent is removed. Urinary catheter A catheter (tube draining urine from the bladder) may be temporarily placed following your operation Mild burning or bleeding on passing urine Occasional complications (2-10%). Infection: This can sometimes occur. You may notice you feel generally unwell or develop a fever. You may have ‘cystitis-type’ symptoms but these are very common if you have a stent and do not necessarily mean that you have an infection. You will be asked to provide a urine sample and, if an infection is present, you will be prescribed antibiotics. Unable to gain access: Sometimes the ureter is too narrow to allow a telescope to pass. A stent will then be placed so that the ureter can be stretched and allow a ureteroscopy to be performed in a few weeks’ time. Inability to retrieve the stone Sometimes the stone is in a position that cannot be reached by the ureteroscope. Recurrence of stones New stones can form even after complete clearance of the stone Rare complications (less than 2%). Ureteric perforation: The ureter may be damaged during your operation. In order to allow the ureter to heal a stent may need to be placed (for approximately 6 weeks) or very rarely an open repair is required to repair the damage. Stricture formation or scarring of ureter requiring further intervention Rarely, damage to the ureter may result in a narrowing or stricture. Non-specific complications relating to all surgery: Any form of surgery and general anaesthesia carries the risk of chest infection, clots occurring in the legs (deep vein thrombosis) or lungs (pulmonary embolus), stroke and heart attack. These risks are very low in patients who are otherwise fit and well. If these complications do occur, they may result in a prolonged hospital stay, a period on intensive care or even death. Before the operation You will attend a pre- admission clinic. This is a nurse-led clinic. The purpose of this is to organise tests, e.g. blood tests, heart tracing and to check your fitness for the surgery. You will be asked a detailed questionnaire about your health. You may be given instructions regarding certain medications e.g. blood thinning medications like warfarin and clopidogrel. If the pre-operative nurse has any specific concerns about your fitness for surgery, she may refer you for further tests or ask you to meet a consultant anaesthetist. The pre-admission clinic is an opportunity for you to discuss any questions you may have about the operation and care afterwards. The day of surgery Your admission letter will be sent to you prior to your operation. It will give you instructions on when to stop eating/drinking prior to the operation and also details for coming into the hospital. You will need to bring in all your medication. Depending on your medication, you may have been informed to continue your usual medicine regime or withhold certain medications. You will be admitted on the day of your operation. On admittance to the ward you will be shown to a bed. You will be seen by a doctor, who will check there are no changes since the pre-admission clinic. At this point you will also be ‘marked’, by the doctor with an arrow on your skin to show the correct side. You will also be seen by an anaesthetic doctor who will discuss with you the most appropriate anaesthetic for you. If you have not yet signed your consent form it will be done on admission. You will be asked to wear a theatre gown and to wear special stockings which are designed to reduce the risk of blood clots (deep vein thrombosis] in your lower legs. You may also be given a daily injection just under your skin in your abdomen to prevent blood clots. You will wait on the ward until you are taken to the operating theatre. What does the procedure involve? How long does it last? What does it feel like? The operation Ureteroscopy is usually performed under a general anaesthetic. The length of operation can vary between 30 minutes and 2 hours. No incisions are made as the telescope is passed along the urethra (water pipe) into your bladder and then along the ureter. When the stone is found a laser is then used to break up the stone into smaller pieces. Depending upon the size of these pieces these are either then left to wash out by themselves or are removed with a stone-basket. A ureteric stent may then be placed. If a stent is not used sometimes a ureteric catheter is left overnight. This is a tube similar to a stent but is attached to a normal catheter. Both the ureteric catheter and normal catheter are then removed the following morning by the nurse looking after you. After the operation After the operation you will wake up in a recovery area. When you are fully awake and comfortable you will be taken back to the ward (this may be different to the admitting ward) You may have a catheter (a tube to drain urine from the bladder). If so this is normally removed when you are fully mobile. You may also have intravenous fluids (a drip) going into your arm vein. If you are not feeling nauseous (sick), you will be given drinks and food. This drip is then removed when you are drinking and eating normally. It is not uncommon to feel discomfort/ pain on the side that was operated on. It is therefore important to take painkillers regularly for the first 2 or 3 days. How long will I need to stay in hospital? You will normally be able to go home later the same day as your operation, or occasionally on the following day. Discharge home. By the time you go home you may have discomfort on the side that has been operated on. You will need to take painkillers for this. You may also notice blood in the urine. This can last for a week or two. It is important to drink plenty on discharge and should be routinely aiming to drink around two litres a day (unless told otherwise by your doctor).
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