When a stone is lodged and stuck in the ureter (tube that drains the kidney to the bladder), it can cause severe pain (renal colic). Some of these stones will not pass spontaneously and will need surgery. Some bigger stones in the kidney that have not dropped down yet, can also be treated pre-emptively. See kidney stones.
Modern surgery now allows small instruments to be passed up the ureter and kidney. This enables direct visualization of the stone, and its fragmentation with a laser fiber accurately with minimal damage to surrounding tissue. The fragments can then be removed with a small basket. Almost complete to complete stone clearance is often achievable. Recovery is quick as there is no open cut.
- Stones in the ureter or kidney.
- Can treat multiple small stones in the kidney.
- Ideally, stones are <2.5cm. Larger ones may need PCNL surgery.
- Can be done as a second procedure after incomplete stone clearance from a first procedure such as ESWL.
- Safe for patients on blood thinning medications.
- Allows stone fragments to be retrieved and sent off for analysis. Some types of stones can be prevented with medical therapy.
If you are taking blood thinners or certain newer diabetic medications, please inform your doctor as these may have to be stopped before the surgery. It is still reasonably safe for some patients to stay on their blood thinners if they are not allowed to stop them.
You will need to fast for at least 6 hours before the surgery.
Your doctor may require you to have blood tests or a urine test prior to the surgery.
See preparing for surgery, for more detailed instructions.
The surgery is done under general anaesthesia. It takes from 30 minutes to a few hours depending on the size, location, hardness, and number of stones. There is no open cut, as it is done using small instruments via the urethra (tube where you pass urine). Intravenous antibiotics are given.
If the stone is in the ureter, a small rigid scope (ureteroscope) is used to go up the ureter from the opening in the bladder. If the stone is in the kidney, a flexible scope (pyeloscope) allows the kidney to be searched as it can bend around the angles.
The stone is visualized and lasered into small fragments, with a Holmium YAG fiber. These fragments are then removed with a small basket and sent off to the lab for stone analysis. Smaller dust particles are usually left behind as these will pass easily later.
Depending on how much swelling there is in the ureter at the end of the surgery, a JJ stent may have to be inserted (see JJ stent insertion). A stent will prevent pain from ureteric obstruction due to the swelling.
In about 10% of cases, the ureter is too tight and does not allow safe passage of the instrument upwards. In this case, the stone cannot be reached and treated. A JJ stent is then inserted. The stent will dilate the ureter in a few weeks and allow a second procedure to be done in a safer manner.
Sometimes, instead of a stent, a ureteric catheter can be inserted. This is attached to a urethral catheter that drains the bladder. Both of these can be removed the following day before discharge.
Most patients either go home on the same day of the procedure or stay for one night in the hospital. If you go home on the same day, wait until you are hungry before trying a light meal. You may still be nauseous from the effects of the anaesthesia.
Do not drive, smoke, drink alcoholic beverages or operate heavy machinery for 24 hours after the surgery.
You should not get too much pain as there is no open wound or cut. There may be a mild burning sensation when you pass urine in the first day or two. Ural sachet drinks can help alleviate this.
You will get mild bleeding in the urine after the procedure. It is very rare to get severe bleeding.
If a JJ stent has been inserted during the procedure, you may get stent symptoms such as urinary frequency, blood in the urine, refluxing aching sensation in the kidney during voiding. These are usually mild, but occasionally can be debilitating and need analgesia.
You may be given antibiotics when you are discharged.
Most patients can go back to work the following 1 – 2 days after discharge. If there is pain from the JJ stent, your ability to work may be affected, depending on the type of work that you do.
If you have a stent, your doctor will inform you when to return to get it removed.
Contact your surgeon immediately if you develop a fever or any other signs of infection.
Contact your surgeon if you have any concerns or questions about your recovery.
You should attend your post-op appointment so your doctor can check for any complications.
- Anaesthetic risks such as heart or lung problems.
- Urinary infection – you will be covered with antibiotics during the surgery.
- Bleeding – it is uncommon to need a blood transfusion for this surgery.
- Clots in the legs (DVT) or pulmonary emboli.
- Chest infection.
- Allergic reactions (e.g., to dressings, drugs etc.) – inform us if you have any known allergies.
- Risk of death is a very rare complication that may arise from any surgery or anaesthetic. Modern medicine and anaesthesia have made this extremely rare. The risk varies with each individual’s general health conditions and the complexity of the surgery. Kidney or ureteric laser stone surgery is not considered to be a major surgery.
- Ureteric damage – if the ureter is tight, and the stone is impacted, there is a small risk of damaging the ureter during the procedure. Totally avulsing the ureter is extremely rare.
- Ureteric scarring or stricture – instrumentation of the ureter can potentially cause scarring and narrowing which can then cause blockage.
- Incomplete stone clearance – some patients may need repeat attempts to clear all the stones especially if the initial stone burden is high.
- Difficulty passing urine – this is uncommon but may occur in men who already have benign prostatic enlargement.
See kidney stones, for other treatment alternatives.