Ureteroscopic lithotripsy (URS)

Ureteroscopic lithotripsy (URS)

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This is endoscopic treatment of ureter stones < 1 cm size using a mini-scope. Under general anaesthesia, the scope is passed via the urethra into the bladder and up the ureter. Using a laser or lithoclast probe, direct contact is made on the stone to break it into smaller pieces. These tiny stone pieces will pass out on their own. If needed, a wire basket can be used to extract the stone pieces. This surgery takes 30 mins on average and can be done as a day case under general anaesthesia. Pain and bleeding is usually minor. Occasionally, a double-J (DJ) stent may need to be inserted after the procedure if there is any injury to the ureter wall or if there is gross swelling of the kidney caused by the stone. The success rate for stones lodged in the lower ureter is near 100%. For stones lodged at the mid- to upper ureter, there is a chance they may float up into the kidney beyond the reach of the scope. If this happens, then a DJ stent is inserted and the stone managed by ESWL.

The advantages of this method over ESWL is that even hard stones can be broken and the ureter opening is simultaneously dilated by the scope to facilitate subsequent stone passage.

Complications include:

  • bloody urine. This should clear up in a few days.
  • perforation of the ureter. If this happens, urine leak and pain results. A DJ stent will need to be inserted to prevent further urine leak and promote adequate healing of the ureter.
  • Stone migration. Because pressurized water is used to gain clear vision of the ureter and stone, the pressure may sometimes push the stone up beyond the reach of the ureteroscope. If this happens, a DJ stent is inserted and alternative method, i.e. ESWL is chosen.