Ureteroscopy

What is a ureteroscopy (URS)?

Ureteroscopy is a urological procedure performed for both diagnostic and therapeutic purposes. Using a flexible instrument known as an endoscope, doctors can examine the ureter as well as the renal pelvis and calyces. In addition, specialized surgical tools can be inserted through the endoscope, enabling immediate treatment when needed.

The kidneys function as filters for the blood, removing waste substances that are then eliminated through urine. The renal pelvis and calyces collect this urine and transfer it to the ureters, which carry it to the bladder. From there, it is eventually expelled through the urethra.

Various conditions can affect the renal pelvis and urinary tract, each requiring specific diagnostic and treatment approaches. Ureteroscopy provides a way to both identify these conditions and, when necessary, treat them directly.

When is a ureteroscopy performed?

The indications for a ureteroscopy can be divided into diagnostic and therapeutic purposes. The procedure also allows both to be combined in one session and the procedure to be adapted to the individual findings.

The diagnostic purposes include, in particular, investigating suspicious tumor findings. The procedure is particularly suitable for this because a tissue sample (biopsy) can be taken directly after inspecting the abnormal area. Ureteroscopy can also be used to investigate the underlying cause of blood in the urine (micro- or macrohaematuria).

The therapeutic indication for the procedure is often the removal of stones from the renal pelvis or the urinary tract. Furthermore, it is also used to widen narrowings of the ureter, also known as stenoses, and to remove tumors.

As with every procedure, there are certain contraindications for ureteroscopy. These include untreated urinary tract infections or the use of blood thinners. During pregnancy, ureteroscopy should also only be carried out if it is deemed particularly urgent.

How does the specialist carry out this procedure?

Before performing a ureteroscopy, laboratory tests are conducted to check specific blood values and analyze the urine. Various imaging techniques are also used to determine whether the procedure is necessary. In addition to an ultrasound examination, this usually includes an intravenous urogram and a CT scan. If it is thought to be necessary, the patient undergoes a detailed consultation to discuss the procedure.

Ureteroscopy is typically performed under general anesthesia. The patient is positioned in the lithotomy position, lying on their back with the knees and hips flexed and slightly apart. This positioning provides the surgeon with a clear view of the urethra.

In most cases, a retrograde ureteroscopy is performed, meaning the urinary tract is examined against the normal flow of urine. The instruments are inserted through the urethra into the bladder, then advanced into the ureter and renal pelvis.

At the beginning of the procedure, a cystoscopy (bladder endoscopy) is always performed. A guidewire is then inserted into the renal collecting system, along which the endoscope is introduced. The endoscope consists of a flexible tube with a camera and light source at its tip. Additionally, it has a working channel through which surgical instruments like forceps or clamps can be used.

Depending on the findings, the specialist will examine the urinary tract and, if necessary, treat any abnormalities during the same procedure.

If the ureter is particularly narrow, a ureteral stent may be placed at the end of the procedure. This prevents postoperative urine flow obstruction caused by irritation or swelling in the ureter and is typically removed after a few weeks.

Is a ureteroscopy painful?  

As ureteroscopy is performed under general anesthesia, it is a completely painless procedure. Nevertheless, as the mucous membranes of the urinary tract are irritated by the endoscopy, there may be some pain following the procedure. This pain can normally be effectively managed with painkillers.

How long does the procedure take?

The duration of the examination depends on the indication and the findings. If it is a purely diagnostic ureteroscopy, the procedure usually takes no longer than about 30 minutes. If additional therapeutic measures are carried out, the procedure will take longer. However, a ureteroscopy normally does not take longer than 60 to 90 minutes.

What do I need to consider before and after a ureteroscopy?

After the first examinations are completed, a detailed consultation takes place between the performing doctor and the patient. During this discussion, the procedure, potential risks, and possible side effects of the surgery are explained.

Since the procedure is performed under general anesthesia, the patient must be fasting beforehand. Furthermore, certain medications may need to be discontinued prior to the surgery.

After the procedure, a short hospital stay of about two days is usually required for monitoring. Once discharged, the patient will have regular follow-up appointments with a urologist. If a ureteral stent was placed during the procedure, it can typically be removed after about two weeks, usually without the need for anesthesia.

Which doctors & clinics specialize in performing ureteroscopy?

The diagnosis and treatment of diseases of the kidneys and urinary tract falls under the specialty of urology. Urologists specializing in the performance of ureteroscopy are therefore surgical urologists who, depending on the clinical condition, work together with specialists in internal medicine, oncology or surgery.

Since ureteroscopy, like any surgical procedure, carries potential risks, patients want to rely on the expertise and experience of the performing urologist. We aim to help patients find the right specialist for their procedure.

That is why all the doctors listed here have been carefully reviewed and selected. They are experts in their field with extensive experience in performing ureteroscopy. See for yourself the expertise of our specialists and schedule your initial consultation today.

Sources:

• Hautmann, Gschwend: Urologie. 5. Auflage. Springer-Verlag 2014.
• Amboss, Nachschlagewerk für Mediziner.  -https://next.amboss.com/de/article/c50aQg#Zcdffd373cda40ce412b536d64efa12a3
• Thomas Knoll, Arkadiusz Miernik: Urolithiasis- Diagnostik, Therapie, Prävention. Springer-Verlag. 2021.