What is the prep for ureteroscopy?
At the hospital or surgery center
You don't have to do a lot to get ready for a ureteroscopy. You'll need to pee before the procedure. Your doctor or a nurse will tell you when. You should also get instructions about how long before the surgery you need to stop eating, drinking and taking some medicines.
You will need to rest for 24 hours. You should have someone stay with you during that time. Your surgeon will likely prescribe medicines for you to take at home. This may include a pain medicine and an antibiotic to prevent infection.
Ureteroscopy is a minimally invasive method to treat kidney stones as well as stones located in the ureter. It is performed in the operating room with general or spinal anesthesia, and is typically an out-patient procedure (you go home the same day).
For most operations, you do not need to have the hair around the site of the operation removed.
You will also get a prescription for pain pills. You can use these prescription pain pills in addition to acetaminophen every for hours. Do not exceed 4000mg acetaminophen per day. You may also be given a prescription for tamsulsin (Flomax), this helps relax the urinary system and ease discomfort from the stent.
- NO lifting heavy objects (anything greater than 10 lbs) for 4 weeks.
- NO driving a car and limit long car rides for 2 weeks.
- NO strenuous exercise, limit stair climbing to minimum for 4 weeks.
- NO severe straining during bowel movements – take a laxative if necessary.
Your Recovery
For several hours after the procedure you may have a burning feeling when you urinate. This feeling should go away within a day.
After the Procedure
Depending on the procedure, you may need a catheter to drain urine. You may also be prescribed pain medication or antibiotics. Urination may be painful or contain blood at first.
The most frequent reason for ureterorenoscopy is the necessity to remove calculi from the ureter and/or kidney. After completing this procedure the Foley catheter is inserted in the bladder.
What size kidney stone requires ureteroscopy?
| Size of kidney stones | Chances of passing naturally | Treatment |
|---|---|---|
| 4-7mm | About 60% | Home remedies and painkillers |
| Larger than 7mm | About 20% | Ureteroscopy |
| 1-2cm | Cannot pass | Lithotripsy |
| Larger than 2cm | Cannot pass | Percutaneous nephrolithotomy |
Most ureteroscopy is performed effectively and safely in the supine position.
Diet: You may return to your normal diet immediately. Because of the raw urinary tract surfaces, alcohol, spicy foods, and drinks with caffeine may cause some irritation or frequency of urination and should be used in moderation.
- Green leafy vegetables like spinach, mustard, and beet greens.
- Cabbage, cauliflower, tomatoes.
- Banana, mango, apricot, grapes.
- Nuts like almond and cashew.
- Alcohol.
- Soft drinks.
- Soda.
- Caffeinated drinks like tea and coffee.
Results: Ureteral stent discomfort, ureteral wall injury and stone migration are the most frequently reported complications. The worst complications include urosepsis, multi-organ failure and death.
Postoperative Pain: Most patients after ureteroscopy experience mild to moderate pain in the flank and/or bladder area. This is generally well controlled by use of oral narcotics (pain medication) such as Percocet or Vicodin.
Pain management
Your doctor may recommend a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen or diclofenac. A warm bath can also help. If your pain is more intense, you may need a stronger painkiller. Your doctor may also give you medication to help make it easier to pass pieces of stone.
Your healthcare provider gently pulls on the string to remove the ureteral stent. If you need a ureteral stent for a few weeks or longer, the stent won't have a string. Your provider removes the stent during a minor office procedure. You may get X-rays or an ultrasound before removal.
Urinary stent removal may involve an in-office cystoscopy or an at-home removal with a string. The process should only take a few minutes. Though the procedure itself shouldn't hurt much, many people report feeling some level of pain and discomfort afterward.
Expect to experience red urine, flank pain, bladder irritation, and urinary frequency and urgency after the stent is placed. Take prescribed pain medication, anticholinergic or alpha-blocker medication to alleviate pain and discomfort. Drink plenty of fluids and avoid sugary drinks, caffeine, and alcohol.
What color is your urine after a ureteroscopy?
Some blood in the urine is normal after a ureteroscopic procedure. Urine colors can range from light pink to reddish and can even have a brownish hue — but you can typically see through it. Medications to help with the burning sensation can turn the urine into an orange or blue color.
In the United States the 2012 AUA guidelines9 recommend antibiotic prophylaxis in all patients scheduled for an endourologic intervention. In cases undergoing ureteroscopy for ureteric stones Preminger et al. recommend antibiotic prophylaxis regardless of the urine culture outcome.
Conclusion: Routine placement of a ureteral stent is not mandatory in patients without complications after ureteroscopic lithotripsy for impacted ureteral stones.
Cost Range (in INR)
Rs. 25,000 to Rs. 1,20,000.
If the stone is small, it may be snared with a basket device and removed whole from the ureter. If the stone is large, or if the diameter of the ureter is narrow, the stone will need to be fragmented, which is usually accomplished with a laser. Once the stone is broken into tiny pieces, these pieces are removed.
