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Ureteroscopy Indications
There are many reasons why access to the ureter would be indicated. These include ureteral stones, strictures and tumor.
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Ureteral stones typically are formed within the kidney and then pass down into the ureter where they get lodged. Once stuck within the ureter the kidney becomes obstructed and pain ensues. Not only is this extremely uncomfortable (likened to having a baby) but when associated with infection it is life threatening. Ureteroscopy allows the surgeon to access the stone, disintegrate it with a laser and/or remove it with a basket. This is all performed without an incision.
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Strictures are narrowings of the ureter associated with abnormal, unhealthy tissue. Strictures may form in the ureter from congenital abnormalities, passage of stones, previous surgery, or radiation therapy. Ureteroscopy allows the surgeon to locate the stricture and repair the stricture using balloon expansion, electrical incisions or lasers.
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Cancer, which forms from the lining of the urinary system, is known as transitional cell carcinoma and may arise anywhere along this tract. When transitional cell carcinoma occurs within the kidney or ureter it is a particularly difficult problem. Ureteroscopy has allowed the minimally invasive urologist to more accurately diagnose this disease and in certain situations treat the cancer through the ureteroscope avoiding the need for surgical procedure that removes the entire kidney and ureter.
Procedure
The ureteroscope is introduced via the urethra, traverses the bladder and enters the ureteral orifice. Ureteroscopes may be rigid or flexible. All have a lens on their tip which provides a magnified view of the ureter and one or two working ports through which the surgeon can introduce special instruments such as lasers, graspers and balloon dilators. Diagnostic procedures typically last 30 minutes to an hour. Therapeutic procedures are longer in duration. Many patients are sent home the same day or within 24 hours of the procedure. In some patients a temporary internal catheter is placed which spans the ureter. It is removed within 3-10 days in most cases.
Results Stones within the ureter managed ureteroscopically have had excellent results. Stone free rates are extremely high with a low complication rate. The majority of patients return home the day of or 24 hours after the procedure.
In terms of strictures the success of ureteroscopy is dependent on the length of the stricture, and the cause of the stricture. In certain circumstances an intraluminal ultrasound is utilized to better delineate the nature of the stricture and direct endoscopic incision.
To diagnose transitional cell carcinoma ureteroscopy is one of the best tests available. It allows the urologist to view the entire lining of the ureter and kidney. When a lesion is found a biopsy is taken and sent for pathologic evaluation. This information helps us grade and stage the lesion. In low grade, low stage lesions ureteroscopic treatment may be all that is required.
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