Information about your procedure from

The British Association of Urological Surgeons (BAUS)

This leaflet contains evidence-based information about your proposed

urological procedure. We have consulted specialist surgeons during its
preparation, so that it represents best practice in UK urology. You should
use it in addition to any advice already given to you.
To view the online version of this leaflet, type the text below into your web
browser:
http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Ureteroscopy for
stone.pdf

Further general information about kidney stones can be found on the

Patients’ section of the BAUS website under "I think I might have … kidney
stones".

Key Points
• The aim of this procedure is to fragment stones in the ureter (the
tube that drains urine from the kidney into the bladder) or kidney,
using a thin telescope passed into the bladder through the urethra
(waterpipe)
• We use a “semi-rigid” telescope (ureteroscope) for stones in the
ureter and a flexible ureteroscope to treat stones in the kidney
• Stones are usually broken up using laser energy passed through a
small laser fibre
• Ureteroscopy has largely eliminated the need for open surgery to
remove stones
• Laparoscopic (keyhole), robotic-assisted or open surgery can be
used if the stone is too large to be fragmented with a ureteroscope

What does this procedure involve?

This involves using a telescope (semi-rigid or flexible) passed into your
bladder through your urethra (waterpipe) to fragment and/or remove
stones from your ureter or kidney. We sometimes need to leave a
temporary stent in your ureter after the procedure.

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What are the alternatives?
• Observation – most stones smaller than 5mm in diameter pass by
themselves but larger stones (greater than 7mm diameter) rarely do
• Extracorporeal shockwave lithotripsy (ESWL) – this involves
using a machine that generates shockl waves which travel through
your skin to break the stone into fragments which you then pass
yourself
• Antegrade ureteroscopy – stones in the upper ureter (close to the
kidney) can be treated by percutaneous (keyhole) puncture of the
kidney so that a ureteroscope can be passed down to the stone from
above
• Laparoscopic (keyhole) or robotic stone removal – for extremely
large or impacted stones in the ureter
• Percutaneous nephrolithotomy (PCNL) – for large stones in the
kidney which may not be suitable for flexible ureteroscopy
• Open stone removal – although very unusual nowadays, if all the
above techniques fail we may need to resort to open surgery, through
an incision in your side, to remove your stone(s)

What happens on the day of the procedure?

Your urologist (or a member of their team) will briefly review your history
and medications, and will discuss the surgery again with you to confirm
your consent.

An anaesthetist will see you to discuss the options of a general anaesthetic

or spinal anaesthetic. The anaesthetist will also discuss pain relief after the
procedure with you.

We may provide you with a pair of TED stockings to wear, and we may give
you a heparin injection to thin your blood. These help to prevent blood
clots from developing and passing into your lungs. Your medical team will
decide whether you need to continue these after you go home.

If you have a stone in your ureter, we usually arrange an X-ray or,

occasionally, a CT scan for you on the day of the operation, to be sure that
the stone has not passed by itself.

Details of the procedure

• we normally use a full general anaesthetic and you will be asleep
throughout the procedure
• we usually give you an injection of antibiotics before the procedure,
after you have been checked for any allergies

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 • we put a telescope into your bladder, through your urethra
(waterpipe), and use it to put a guidewire up into your kidney, past
the stone in the ureter, using X-ray control.
• we then put the ureteroscope (semi-rigid or flexible) up to the level of
the stone by following the guidewire
• we fragment the stone using an energy source; this is usually a laser
but, occasionally, we use a lithoclast (a tiny pneumatic drill)
• using the laser, we either “dust” the
stone, leaving tiny fragments which
can pass by themselves, or break it
into smaller pieces (pictured) which
can be removed using special grasping
devices
• we may insert a temporary drainage
tube (a ureteric catheter, or a stent
with a string attached) into the ureter
at the end of the procedure; this is
removed later and your urologist will
arrange this for you
• occasionally, we need to perform a “second-look” ureteroscopy at a
later stage to treat residual stones; if this is needed, we leave a stent
in your ureter until the second procedure
• occasionally, we put in a bladder catheter which is removed the
following morning
• many patients will be able to go home on the same day as their
procedure or early on the first post-operative morning
If you have been admitted as an emergency (with a stone blocking your
ureter), you may have had several tests and other treatment already. This
means your stay in hospital will, inevitably, be longer than a single day.
Further information and a short video of ureteroscopic stone removal are
available on the BAUS website.
Are there any after-effects?
The possible after-effects and your risk of getting them are shown below.
Some are self-limiting or reversible, but others are not. The impact of after-
effects can vary a lot from patient to patient; you should ask your surgeon’s
advice about the risks and their impact on you as an individual:

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After-effect Risk
Mild burning or bleeding on passing urine
Almost all
for a short time after the procedure
patients
(especially if you have a ureteric stent)

Temporary insertion of a ureteric stent Almost all

which needs to be removed later patients

Recurrent (new) stone formation over the

1 in 2 patients
next five to 10 years, requiring further
(50%)
surgery or other treatment
Residual stones requiring further surgery Between 1 in 7 &
or other treatment (more likely for stones 1 in 20 patients (5
closer to the kidney) to 15%)
Failed to access the ureter (or reach the
1 in 20 patients
stone) requiring further surgery or other
(5%)
treatment

Between 1 in 10 &
Temporary insertion of a bladder catheter
1 in 50 patients

Between 1 in 50 &
Infection requiring antibiotic treatment
1 in 100 patients

Minor damage to the wall of the ureter

(small perforation, mucosal abrasion, 1 in 100 patients
bleeding) requiring stenting or (1%)
percutaneous nephrostomy

Narrowing of the ureter due to delayed scar Between 1 in 100

formation (stricture) which may require & 1 in 250
further treatment patients

Major damage to the wall of the ureter Less than 1 in

(large perforation, avulsion of the ureter) 1000 patients
requiring further surgery (less than 0.1%)

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Anaesthetic or cardiovascular problems Between 1 in 50 &
possibly requiring intensive care (including 1 in 250 patients
chest infection, pulmonary embolus, stroke, (your anaesthetist
deep vein thrombosis, heart attack and can estimate your
death) individual risk)

What is my risk of a hospital-acquired infection?

Your risk of getting an infection in hospital is between 4 & 6%; this includes
getting MRSA or a Clostridium difficile bowel infection. This figure is higher
if you are in a “high-risk” group of patients such as patients who have had:
• long-term drainage tubes (e.g. catheters);
• bladder removal;
• long hospital stays; or
• multiple hospital admissions.

What can I expect when I get home?

• you will be given advice about your recovery at home
• you will be given a copy of your discharge summary and a copy will
also be sent to your GP
• any antibiotics or other tablets you may need will be arranged &
dispensed from the hospital pharmacy
• you should drink twice as much fluid as you would normally for the
first 24 to 48 hours, to flush your system through and reduce the risk
of infection
• recovery from ureteroscopy is usually rapid; you may return to work
when you are comfortable enough and when your GP is satisfied with
your progress
• if you have had a stent put in, it may cause pain in your kidney area
when you pass urine, or pain in your bladder; this usually settles
quickly but, if you feel unwell or feverish, you should contact your GP
to check for a urine infection
• if you develop a fever, pain in the area of the affected kidney, severe
pain on passing urine, inability to pass urine or worsening bleeding,
you should contact your GP immediately

You can reduce your risk of further stone formation by altering your diet
and fluid intake. Ask your urologist or specialist nurse for further details
about this or download the BAUS leaflet “Dietary advice for stone formers”.

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General information about surgical procedures
Before your procedure
Please tell a member of the medical team if you have:
• an implanted foreign body (stent, joint replacement, pacemaker,
heart valve, blood vessel graft);
• a regular prescription for a blood thinning agent (e.g. warfarin,
aspirin, clopidogrel, rivaroxaban, dabigatran);
• a present or previous MRSA infection; or
• a high risk of variant-CJD (e.g. if you have had a corneal transplant, a
neurosurgical dural transplant or human growth hormone
treatment).

Questions you may wish to ask

If you wish to learn more about what will happen, you can find a list of
suggested questions called "Having An Operation" on the website of the
Royal College of Surgeons of England. You may also wish to ask your
surgeon for his/her personal results and experience with this procedure.

Before you go home

We will tell you how the procedure went and you should:

• make sure you understand what has been done;

• ask the surgeon if everything went as planned;
• let the staff know if you have any discomfort;
• ask what you can (and cannot) do at home;
• make sure you know what happens next; and
• ask when you can return to normal activities.

We will give you advice about what to look out for when you get home.
Your surgeon or nurse will also give you details of who to contact, and how
to contact them, in the event of problems.

Smoking and surgery

Ideally, we would prefer you to stop smoking before any procedure.
Smoking can worsen some urological conditions and makes complications
more likely after surgery. For advice on stopping, you can:
• contact your GP;
• access your local NHS Smoking Help Online; or
• ring the free NHS Smoking Helpline on 0300 123 1044.

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Driving after surgery
It is your responsibility to make sure you are fit to drive after any surgical
procedure. You only need to contact the DVLA if your ability to drive is
likely to be affected for more than three months. If it is, you should check
with your insurance company before driving again.

What should I do with this information?

Thank you for taking the trouble to read this information. Please let your
urologist (or specialist nurse) know if you would like to have a copy for
your own records. If you wish, the medical or nursing staff can also arrange
to file a copy in your hospital notes.

What sources have we used to prepare this leaflet?

This leaflet uses information from consensus panels and other evidence-
based sources including:
• the Department of Health (England);
• the Cochrane Collaboration; and
• the National Institute for Health and Care Excellence (NICE).

It also follows style guidelines from:

• the Royal National Institute for Blind People (RNIB);
• the Information Standard;
• the Patient Information Forum; and
• the Plain English Campaign.

Disclaimer
We have made every effort to give accurate information but there may still
be errors or omissions in this leaflet. BAUS cannot accept responsibility for
any loss from action taken (or not taken) as a result of this information.

PLEASE NOTE
The staff at BAUS are not medically trained, and are unable to answer
questions about the information provided in this leaflet. If you do have
any questions, you should contact your urologist, specialist nurse or GP.

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