Ureterorenoscopy and Lithotripsy

What is URSL?

URSL (Ureterorenoscopy and Lithotripsy) is a minimally invasive procedure used to treat kidney stones located in the ureter, the tube that connects the kidney to the bladder. This procedure involves using a ureteroscope, a thin, flexible tube with a camera, which is inserted through the urethra, bladder, and into the ureter to visualize the stone. Once the stone is located, laser lithotripsy is performed to break the stone into smaller fragments, which can either be removed with special instruments or left to pass naturally through the urine.

URSL is commonly used for stones that are too large to pass naturally but are accessible via the ureteroscope. It is an effective, safe, and minimally invasive alternative to more invasive surgical options for treating ureteral stones.

1.2 Indications for URSL

URSL is typically recommended for patients with ureteral stones that are too large to pass naturally or are causing symptoms such as pain, obstruction, or infection. Common indications for URSL include:

• Ureteral Stones: Stones that are stuck in the ureter and are not passing naturally through the urinary system.
• Kidney Stones in the Lower Ureter: Stones located near the bladder that are causing discomfort or obstruction.
• Failed Medical Expulsive Therapy: Stones that have not passed despite medication or other non-surgical treatments.
• Obstructive Uropathy: Stones causing a blockage in the ureter, leading to obstruction of urine flow.
• Recurrent Infections: Recurrent urinary tract infections (UTIs) due to the presence of stones.
• Severe Pain: Persistent or severe pain from kidney stones that does not improve with medications.

URSL is also indicated when other non-invasive techniques, such as shockwave lithotripsy, are not suitable or have failed.

1.3 The URSL Procedure

The URSL procedure is performed under general or spinal anesthesia and usually lasts between 30 minutes to an hour, depending on the size and location of the stone. The steps involved in the procedure include:

1. Anesthesia: The patient is given general or spinal anesthesia to ensure comfort during the procedure.
2. Insertion of Ureteroscope: The surgeon inserts the ureteroscope through the urethra, into the bladder, and then into the ureter to locate the stone. The camera on the ureteroscope allows the surgeon to see the stone clearly on a monitor.
3. Lithotripsy: Once the stone is visualized, a laser fiber is passed through the ureteroscope to break the stone into smaller pieces. This technique is called laser lithotripsy.
4. Stone Removal: The small fragments are either removed using special instruments or left to pass naturally in the urine over time.
5. Stent Placement (if necessary): In some cases, a ureteral stent (a small tube) is placed in the ureter to keep it open and ensure smooth urine flow. This is temporary and is removed after a few days or weeks.

The procedure is minimally invasive, and patients are typically allowed to go home the same day or after a short observation period.

1.4 Benefits of URSL

URSL offers several advantages compared to more invasive surgical treatments for kidney stones:

• Minimally Invasive: URSL does not require any external incisions, reducing recovery time and post-operative discomfort.
• Effective for Larger Stones: It is highly effective in treating stones that are too large to pass naturally, particularly in the ureter.
• Quick Recovery: Patients can usually return home the same day and resume normal activities within a few days.
• Precise Stone Removal: The use of a laser allows for precise targeting of the stone, minimizing damage to surrounding tissues.
• No Need for Incisions: Since the procedure is performed entirely through natural openings (the urethra), there are no external scars or incisions.

URSL is highly successful in treating ureteral stones, especially when other non-invasive treatments have failed.

1.5 Recovery After URSL

Recovery after URSL is generally quick and smooth, with most patients experiencing only mild discomfort. Here’s what to expect:

• Hospital Stay: URSL is usually performed as an outpatient procedure, meaning patients can go home the same day. In some cases, an overnight stay may be required.
• Pain and Discomfort: Some mild pain, burning during urination, or blood in the urine (hematuria) is common for a few days after the procedure. Pain medications or anti-inflammatory drugs may be prescribed to manage discomfort.
• Stent Removal: If a stent is placed, it is typically removed after 1-2 weeks. This can cause some mild discomfort, but the removal process is quick and usually done in the doctor’s office.
• Back to Normal Activities: Most patients can return to work or normal activities within a few days, although strenuous physical activity should be avoided for at least one week.
• Follow-Up: A follow-up appointment is usually scheduled to ensure proper healing and to check for any remaining stone fragments. In some cases, an imaging test, such as an X-ray or ultrasound, may be done to confirm that the stone has been fully cleared.

Patients are advised to drink plenty of water to help flush out any remaining stone fragments and prevent new stones from forming.

1.6 Post-Procedure Care for URSL

Post-procedure care is important to ensure a smooth recovery and prevent complications. Here are some key aspects of post-URSL care:

• Hydration: Drinking plenty of water is crucial to help pass any remaining stone fragments and to keep the urinary system clear. Aim for at least 8-10 glasses of water per day.
• Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage mild discomfort. If the pain is more severe, your doctor may prescribe stronger pain medication.
• Avoid Strenuous Activity: Patients should avoid heavy lifting or strenuous exercise for at least a week after the procedure to prevent complications.
• Monitor for Signs of Infection: Watch for symptoms of infection, such as fever, chills, or cloudy or foul-smelling urine. If any of these symptoms occur, contact your doctor immediately.
• Stent Care: If a stent is in place, avoid activities that can dislodge it, such as vigorous exercise. It’s important to follow your doctor’s instructions for stent care and attend any scheduled appointments for stent removal.
• Dietary Changes: Depending on the type of stones removed, your doctor may recommend dietary adjustments to reduce the risk of stone recurrence. For example, reducing salt and oxalate-rich foods may help prevent future stones.

By following these post-procedure guidelines, patients can ensure a quicker recovery and reduce the likelihood of future stone formation.