URS

Ureterorenoscopy
In the URS treatment, an ureteroscope which is a small, fiber optic surgical instrument (small caliber endoscope) is used to have a better access to the uretery or kidney stones. Ureteroscope facilitates the direct the visibility of the stones. URS is prefered over SWL (lithotripsy) when the stone size is less than 2cms.

Advantages of Ureterorenoscopy:

  • Easy breakage of hard stones
  • Very safe, speedy recovery and relives prolonged pain.
  • Minimal ureter injury
  • No incisions
  • Highly successful breakage of stone

Length Of The Surgery:

30 to 45 minutes

Diagnosis:

URS – Uteroscopic Stone Removal –  Ureterorenoscopy  is recommended after the following diagnosis tests.

  • Physical exam
  • Medical history.
  • X-ray.
  • CT scan.
  • MRI scan.
  • Sonogram.
  • KUB.
  • EKG (electrocardiogram)
  • CBC (complete blood count)
  • PT / PTT (blood coagulation profile)
  • Comprehensive Metabolic Panel (blood chemistry profile)
  • Urinalysis

Preparation:

Certain medications to be specifically avoided pre surgery:

  • Avoid drinking/ eating 6-8 hours prior.
  • Avoid blood thinning agents like clopidogrel/ aspirin/ warfarin.
  • Avoid anti inflammatory, non- steroidals 7 to 10 days prior.
  • Ensure sterile urine by a MSU- mid stream urine test.
  • Get urine infections treated before this surgery.

Procedure:

  • General anesthesia is given to the patient.
  • A uteroscope which is a a small device like a basket, is inserted through urethra to ureter or via the bladder to the kindey.
  • The stone is located through this device.
  • If the stone is laser in size, then it is fragmented by using laser energy.
  • With the uteroscope’s basket like structure, the stone is held and removed.
  • Most of the times, the urologist places a ureter stent, which helps prevent swelling and infections after the surgery.

Risks:

  • The URS potential risks include:
  • Blood in the urine for a few days.
  • Ureter perforation resulting into pain and leakage of urine.
  • Migration of stone: The pressurised water which is used for clear vision may further push the stone beyong the kidney and ou of reach.

Post Surgery symptoms:

  • Urine leakage.
  • Occurence of blood.
  • Stinging/ burning sensation.
  • Pain in the operated area.

Follow-up:

It’s usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms that suggest there could be a problem, such as:

  • 24 hour surveillance.
  • Normal activity can be resumed after 2 days.
  • For urine leakage, ADJ stent are recommended to be used.
  • For stone migration, DJ stent is then inserted and also if required ESWL is scheduled.
  • Increase water intake to 2.5 litres/ day ie 8 glasses.
  • Visit doctor:
  • Removal of stent 2 3 weeks after surgery.
    Emergency Follow up:
  • Worsening pain in flank/ kidney
  • Large amounts of blood clots in the urine.
  • Difficult/ painful voiding and fully emptying the bladder.
  • Fever

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.