Ureterorenoscopy: the 4 steps preparation, the procedure and the follow up
The ureterorenoscopy (URS) is a medical procedure used to both diagnose and treat specific conditions that affect the ureter and the renal pelvis, which is the part of the kidney where urine collects before entering the ureter.
The ureters and the urethra
The ureters are part of the urinary system. Their function is to filter blood and create urine as a waste product. Thus, the ureters carry urine from the kidneys to the bladder.
Ureters and urethra are often mistakenly considered the same thing, but they’re different parts of the urinary system with different functions. The urethra is a tube that connects the bladder to the urinary meatus to remove the urine from the body of both males and females.
Uretal conditions
Many conditions that affect the ureters (called uretal conditions) can be the result of an infection.
The most common uretal condition are the kidney stones, affecting 10% of the male population. Kidney stones form when waste builds up in the kidneys, sticking together. Sometimes these stones are small enough to pass through the ureter, and in this case the person experiences no symptoms. But other times they’re too large and get stuck. In this case the person may experience:
- Cramping in the lower abdomen and groin;
- Painful urination, sometimes with blood in the urine;
- Burning sensation while urinating.
People affected by these symptoms may be suitable to undergo an ureterorenoscopy to solve their condition.
Ureterorenoscopy meaning and treatment
The ureterorenoscopy involves the use of a thin, flexible tube called ureteroscope to examine the inside of the ureter and renal pelvis.
The procedure allows to diagnose and treat conditions such as the already mentioned kidney stones and tumors.The ureterorenoscopy is a minimally invasive procedure, used when other diagnostic or treatment methods doesn’t seem suitable
Preparation for the procedure
Before undergoing an ureterorenoscopy the patient must follow a 4-steps preparation path:
1 – If needed, a physical examination performed along with X-Ray and ultrasound.
2 – Discontinuing specific medications such as anticoagulants and blood thinners like aspirin at least one week before surgery. The doctor must be then informed about all the other medications the patient takes regularly.
3 – A treatment involving antibiotics before performing the procedure.
4 – Avoiding food and water for 6 to 8 hours before undergoing the procedure.
The procedure
During the procedure, the ureteroscope is passed through the urethra, the bladder and up into the ureter and renal pelvis. Meanwhile, thanks to the technically advanced ureteroscope, the doctor visualizes the interior of these structures on a screen.
The procedure may involve specific procedures such as the destruction of the kidney stones through laser energy or their removal with the help of small tools.
Once the stones are removed or destructed, a catheter or double-J stent gets placed inside the patient temporarily.
A procedure similar to ureterorenoscopy is the flexible ureterorenoscopy (fURS). The main difference consists in the fact that for the latter a flexible ureteroscope is used.
The ureteroscope
The ureteroscope is the medical instrument used by the doctor to perform an ureterorenoscopy. It allows to visualize the inside of the ureter, the bladder and the kidneys.
The main features of the ureteroscope
The main features of the ureteroscope include:
1 – Light source: ureteroscopes are equipped with a light source to illuminate the urinary tract, allowing for clear visualization.
2 – Camera: a small camera is positioned at the tip of the ureteroscope. This camera captures real-time images of the inside of the urinary tract.
3 – Working channels: the ureteroscope may also include working channels that allow the passage of small instruments for the therapeutic procedures.
Differences between rigid and flexible ureteroscope
As already mentioned, the ureterorenoscopy can be regular or flexible. The latter uses an instrument called flexible ureteroscope, which differs from the rigid one for many aspects.
The rigid ureteroscope:
1 – Is a rigid, straight and inflexible tube with a diameter typically ranging from 6 to 9 millimeters.
2 – Due to its shape, it is more effective for procedures involving areas with less curvature, such as the lower ureter.
The flexible ureteroscope:
1 – Is a thin, flexible tube that can navigate even through the curved parts of the ureter.
2 – Its diameter is usually smaller than the rigid one’s.
Follow up
After the procedure, there are specific steps that must be followed, and there are symptoms that the patient could experience for a while. Let’s see them in detail:
1 – After the procedure, the patient must be observed for a short period of time in a recovery area.
2 – The patient may expel small amounts of blood in the urine, but that’s a problem that should resolve by itself within a few days following the procedure.
3 – The patient could also experience pain which should be relieved by simple analgesia.
4 – The patient should drink 2 liters of clean water every day to prevent infections, unless the doctor told them otherwise.
5 – During this follow up phase, the patient should inform the doctor about any signs of infection or other symptoms they’re experiencing, such as fever, smelling urine, or bloody urine that lasts more than 2-3 days.
Risks and side effects
The ureterorenoscopy is considered safe overall, although there are risks and side effects that can manifest in a small percentage of patients. These include:
1 – Discomfort where the ureteroscope was inserted. In this case local anesthesia may be given to ease the discomfort. This side effect usually lasts around 1 or 2 days.
2 – Less than 1% of the patients experience side effects such as spasm of the ureters, which is a long term complication.
3 – Infection of the urinary tract. This side effect is pretty much uncommon as antibiotics are often prescribed for the procedure.
Who performs an ureterorenoscopy?
The ureterorenoscopy is typically performed by an urologist, who is a specialist who focuses his work on the urinary tract and the male reproductive system. Urologists are specialized in the diagnosis and treatment of the diseases affecting the ureters, the kidneys, the bladder, and the male reproductive organs.
In some cases, the urologist may work in collaboration with other medical professionals, such as radiologists, anesthesiologists and nurses, to ensure the success and safety of the procedures.
Do you need help? Contact us and speak with a private consultant.
