URSL Surgery - Ureteroscopic Lithotripsy
Introduction
The condition of formation and deposition of stones in the kidneys is called Nephrolithiasis. These stones are called Renal Calculi. Sometimes these stones dislodge from the kidneys and descend into the ureters and the urinary bladder. Some stones are small enough to pass out of the urinary bladder through the urethra in the urine. Others might be large enough to block any part of the ureter or may get stuck in the urinary bladder and cannot pass through the urethra. These stones need to be surgically removed when flushing them out is not possible. This is performed by a procedure known as Ureteroscopic Lithotripsy.
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- Calcium Oxalate: Stones composed of calcium when there is excess calcium in the blood
- Uric Acid: Stones composed of uric acid when uric acid levels in the blood are high or when urine is acidic
- Struvite: Stones composed of a mixture of phosphate and calcium when the levels of these substances are high in the blood
- Cystine: These are hexagonal-shaped stones composed of the amino acid cystine. It is a genetic disorder where cystine is not reabsorbed by the kidneys and is usually found in the bladder.
The following conditions may necessitate Ureteroscopic Lithotripsy:
- When renal calculi are stuck and are blocking any part of one or both ureters
- When the flow of urine from the kidney to the bladder is compromised
- When the flow of urine from the bladder through the urethra is compromised
- When stone blockages cause stricture (narrowing) of the ureters
- When there is a backflow of urine into the kidneys due to a block in the ureters, causing hydronephrosis (swelling of the kidneys)
- When x-rays, computed tomography (CT scans), and ultrasound sonography scans show the presence of stones in the urinary tract
- ● When there is an underlying kidney disease
The following symptoms may be seen due to stone formation:
- Severe flank (side of the abdomen) pain, unilaterally or bilaterally
- Blocked urine output
- ● Backflow of the urine into the kidney/s
- Infection or inflammation in the kidneys, leading to pyonephrosis (pus in the kidney)
Ureteroscopic Lithotripsy or URSL is a surgical procedure that involves the use of a ureteroscope and laser stone fragmentation. When shockwaves are not used in surgical procedures to remove stones, lasers are the only other non-invasive procedure option.
A ureteroscope, which is either firm or very flexible, is used depending on the position, size, and composition of the stone/s. This procedure is usually performed on both ureters under general anesthesia. Sometimes heavy sedation or local anesthesia is also used as required.
Small scopes and small-caliber ureteroscopes with laser lithotripsy devices are inserted into the urethra and the bladder and navigated into the ureters. A scope that contains a camera shows surgeons their surgical field, and the guided laser is used to break down stones into tiny fragments. Sometimes stone forceps are used to remove these fragments. Usually, the fragments flush themselves out of the body through the urine.
The surgeon usually places a stent called a Double J Stent (DJ stent). This is a ureteral stent that forces the ureter walls to expand to prevent the backflow of urine and relieve obstruction due to fragmented stones. This stent has curved edges on both sides, which prevent it from slipping down into the bladder or moving upwards into the kidney. It is usually removed after a few weeks of the surgery. Sometimes the stents have threads left dangling outside the urethra so that the stents may be easily pulled out post-recovery.
- Pain in the flanks due to the presence of the stent
- Rupture of the walls of the urinary bladder
- Rupture of the walls of the ureters
- Stricture of the ureters
- Sepsis
- Localized infection
- Bleeding
- Inflammation
- Internal bruising
- Urinary infection
- Bladder infection
- Kidney infection
- Nausea with vomiting
- Hematuria (blood in the urine)
Patients must remember the following points to ensure a speedy recovery.
- Undergo blood tests to ensure proper kidney function
- Undergo blood tests to ensure the levels of the elemental composition of stones are regulated
- Measure the urine output
- Check the urine for the presence of stones, blood, signs of infection, pus cells, etc.
- Ultrasound to ensure there is no internal bleeding or infection
- Stent removal
- Send stones for analysis to determine the stone composition so that the underlying condition may be treated
- Drink enough water to flush out the kidneys, ureters, urinary bladder, and urethra
- Drink enough water to flush out the urinary tract.
- Avoid foods that can precipitate certain kinds of stones.
- Prevent urinary infection by maintaining proper hygiene and urinating frequently.
Nephrolithiasis is a condition that can be prevented. It is also easily treatable. It is important to see a urologist or nephrologist if you feel pain in the sides of your abdomen radiating from the back, experience nausea, have back pain, or notice changes in the urine color. Ureteroscopic Lithotripsy is a safe procedure that uses targeted laser beams and has minimal complications. However, preventing stone formation is very important. A surgical procedure is performed only when all other treatment methods have failed.
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FAQ's
If renal calculi are smaller than 3 mm, your doctor may not suggest surgery unless a complication arises. Stones of this size can be treated by drinking plenty of fluids, avoiding certain foods that can cause further precipitation of stones, and being careful. However, if pain or any other symptoms manifest, it is important to visit your doctor immediately so that they may rule out other possible complications.
Stones in the kidneys usually do not cause too much pain. When fragments or tiny stones pass through the ureter, with some stones causing blockages, pain arises.
Stones bigger than 3-4 mm that cause pain or have created a block in the ureter need to be surgically removed.
There are four kinds of kidney stones. Stones are deposited in the kidneys if their elemental content in the blood is high. So the kidney stones may simply be a symptom of an underlying disease, which causes a rise in the levels of these elements in the blood. Studying the composition helps track the main cause of stone formation. Only then can it be treated.
Stones smaller than 3 mm that do not result in complications can just be flushed out by drinking plenty of fluids. However, if multiple stones or large stones form and cause a blockage in the ureters or result in other complications, it is vital to see a medical health professional. Surgery is performed only when all other treatment options have failed.