Ureteroscopy with Laser Lithotripsy

Ureteroscopy with Laser Lithotripsy Introduction Kidney stones are fairly common. Although kidney stones can be very painful, they are treatable, and in many cases preventable. Your doctor may recommend that you have a ureteroscopy with laser lithotripsy to treat your kidney stones. The decision to have this procedure is yours. This patient education reference summary explains ureteroscopy with laser lithotripsy. It discusses the causes and symptoms of kidney stones and their treatment options. The benefits and risks of ureteroscopy with laser lithotripsy are also presented, followed by what to expect after the procedure. Anatomy Most people are born with two kidneys. Kidneys are bean-shaped organs on both sides of the spine. The main function of the kidneys is to regulate the amount of water in the body and to remove harmful chemicals known as toxins from your blood. The kidneys secrete these toxins into urine. Kidney Ureter Urine flows through tubes called ureters to the bladder, where it is stored. When the bladder is full, people feel the urge to urinate. The urine is emptied through the urethra. Bladder 1

Kidney Stones A person s urine can be high in minerals. If these minerals become too concentrated, they can form crystals, which may then combine and form small, hard stones in your kidney. These stones vary in size from a few millimeters to a few inches. When these stones become dislodged from the kidney, they travel down the ureters towards the bladder. A ureter is a tube that carries urine from the kidney to the bladder. Kidney Stone Most people with smaller stones are able to pass these stones without a problem. Some people, however, experience severe pain when the stones travel through the ureters. This pain is usually located in the back, flank, or groin area, and can last from five to fifteen minutes at a time. This pain is known as renal colic. Sometimes these stones can get stuck in the ureter, especially if they are over 4 mm in size. If a stone gets stuck, the pain can persist for days and the urine flow from the kidney to the bladder might be blocked. The stone may plug the ureter, which can make urine back up and add pressure on the kidney. This is dangerous and can lead to infection and even the loss of the kidney. Because of these complications, it is important to treat these stones. Pain is often the most noticeable symptom of kidney stones. Other symptoms that indicate kidney stones include: nausea, vomiting, bloody or foul-smelling urine, and the constant urge to urinate. Treatment Options Treatment options depend on the patient s symptoms, as well as the size and location of the stone. If the stone is small (usually 4mm or less in size), the urologist, a physician specialized in kidney and bladder diseases, may just wait and see if the patient can pass the stone on his or her own. 2

Patients are usually given medication to help with the severe pain. If your doctor has recommended that you try and pass the stone, you may be asked to drink a lot of fluid, approximately 12 eight-ounce glasses a day, to help flush out the kidney. This is known as expectant therapy. If the symptoms are not very severe, medication can be given in some cases to change the composition of the urine and help dissolve the stone. This takes a long time and is not a good option in cases of severe pain or urinary obstruction. Sometimes the urologist can only reach the stone by making an incision in the back and placing the scope into the kidney and down the ureter. This surgical procedure is known as Percutaneous Stone Removal. Other times, depending on the placement of the stone and size, ESWL, or Extracorporeal Shock Wave Lithotripsy, may be used to break up the stones. ESWL uses shock waves to break down the stone without invasive instruments. A procedure is called invasive when it involves making incisions or inserting instruments into the body. Sometimes ESWL shockwave treatment is not possible because of the location of a stone and other reasons. Your doctor may recommend ureteroscopy with laser lithotripsy. ESWL Treatment During ureteroscopy with laser lithotripsy, your doctor will thread a tiny scope up through your urethra, bladder and ureter to the stone. Powerful miniature lasers are used to break the stone into little pieces. The doctor considers the size, number, location and composition of the stones when recommending a treatment option. The patient s size and medical condition are other factors to consider when exploring treatment options. Ureteroscopy with Laser Lithotripsy Ureteroscopy with laser lithotripsy is performed under general anesthesia. 3

Usually this procedure must be scheduled ahead of time. If you have a blockage, your doctor may need to place a temporary stent immediately. A stent is a long elastic tube placed from the kidney, around the stone, and into the bladder. The stent bypasses the stone and allows urine to drain the kidney. This stent is removed during the laser lithotripsy procedure. During laser lithotripsy the urologist will thread a special scope, called a ureteroscope, through your urethra, bladder and up your ureter to the stone. Using very small cameras, the urologist will be able to see the stone on a monitor. A small but powerful laser is used to break up the stone into little pieces. These pieces are then passed out of the body easily with urine. This procedure does not involve any incisions. Stent After the stone has been broken up by the laser, your doctor may place another stent to keep the ureter open during the healing process. This stent will be removed usually a few weeks after the procedure. Laser lithotripsy is usually an outpatient procedure, which means the patient goes home the same day of the procedure. Risks and Complications Ureteroscopy with laser lithotripsy is a very safe and effective operation. Risks and complications are rare, however, they may happen. Some risks are related to anesthesia and others are related to procedures in general. Risks of general anesthesia include nausea, vomiting, urinary retention, cut lips, chipped teeth, sore throat, and headache. More serious risks of general anesthesia include heart attack, stroke, and pneumonia. Your anesthesiologist will discuss these risks with you and ask you if you are allergic to certain medications. Blood clots in the legs can occur due to inactivity during and after the procedure. These usually show up a few days after the procedure. They cause the leg to swell and hurt. Blood clots can become dislodged from the leg and go to the lungs, where they will cause shortness of breath, chest pain and possibly death. It is extremely important to let your doctors know if any of these symptoms occur. 4

Sometimes the shortness of breath can happen without warning. Getting out of bed shortly after the procedure may help decrease the risk of blood clots in the legs. Infection in the urine or kidneys and bladder is not likely but possible. Severe bleeding that may necessitate a blood transfusion or possibly another operation is also extremely unlikely. There is a small possibility that the procedure may not be successful in breaking the stone. Other risks and complications are extremely rare but possible. These include injury to the urethra, bladder, ureter or kidneys. Such injuries may require surgery and the extremely remote possibility of losing a kidney. After the Procedure After the procedure, you will stay in the recovery room until you have recovered from the general anesthesia. Ureteroscopy with laser lithotripsy is usually an outpatient procedure, which means the patient goes home the same day. Since you will have anesthesia, it is important that someone drive you home. As you recover you may begin to feel better and better. Even so, it is important to rest the day of surgery. Most people can fully resume daily activities one to two days after ureteroscopy with laser lithotripsy. The urologist will suggest that you drink plenty of water in the weeks following the procedure. This will increase the rate of urination, which helps the remaining pieces of stone pass from the body. Most patients have a small amount of blood in their urine after the procedure. This is normal and can last as little as a few days and as long as a few weeks. Some pain may occur when the fragments pass, which begins soon after treatment and may last for up to four to eight weeks. Oral pain medication and drinking lots of water will help relieve symptoms. If you had a stent placed, it may cause some discomfort while urinating. Your doctor may give you special medications for this pain. You will also be asked to come back to have the stent taken out at a later date. 5

Your doctor may ask you to strain your urine, by urinating through a mesh material that will collect any non-liquid substance, following the procedure. This will help confirm that the remaining pieces of stone have passed. You should give these pieces to your doctor. They can help him or her determine the exact make-up of the stone. Knowing what the stone is made of will help you and your doctor understand what caused the stones and how to prevent stones from developing in the future. Urine Straining After determining what the stone s make-up is, the urologist may suggest: drinking a lot of water, in some cases as many as 14 cups a day, participating in physical activity, such as walking, and lowering the salt and animal protein content of your diet. The urologist may also prescribe medications. The type of medication the urologist prescribes depends on the kind of stone you had, so it is important that you retain a sample of the stone and give it to the doctor. Conclusion Kidney stones can be very painful. Fortunately, they are treatable and preventable. If the stone is large and is not passed spontaneously and after taking medications, your doctor may recommend ureteroscopy with laser lithotripsy. Ureteroscopy with laser lithotripsy is an outpatient procedure that uses scopes to reach the stone and a powerful laser to break it up. It is a very safe and effective way to get rid of painful stones. During laser lithotripsy the urologist will thread a scope through your urethra, bladder and up your ureter to the stone. The doctor will then break up the stone into tiny pieces with a powerful laser. Like any procedure, ureteroscopy with laser lithotripsy has risks. Though these risks are rare, knowing about them may help you find them and treat them early. 6