Ureteroscopy And Laser Lithotripsy
Kidney stones affect 1 in 500 Americans each year, causing significant pain and healthcare expense.
Surgical options for patients with symptomatic kidney stones include extracorporeal shock wave lithotripsy , ureteroscopy, and percutaneous nephrolithotomy . Your renal anatomy, stone composition, and body habitus all play major roles in determining outcomes and operative approach.
The role of ureteroscopy over the last ten years has undergone a dramatic evolution, due to improvements in the ureteroscope size and deflection capabilities, video-imaging, miniature baskets and instruments, and in lithotripsy with the advent of holmium laser. Over 25% of all kidney stone surgeries are now done using small ureteroscope technology.
How To Prepare For The Procedure
Always ask your doctor about the treatment steps and any special instructions. These can differ by hospital and country.
Instructions may include:
- when to stop certain medications, such as blood thinners
- when to stop eating and drinking before the procedure to prepare for anaesthesia
- when to empty the bladder before the procedure
- when to arrange pain medication after the procedure, if necessarydiscuss this early with your nurse and/or doctor
- arranging for a ride home after your hospital discharge
Before surgery, someone from your health care teamusually the anaesthesiologistwill assess which type of anaesthesia is appropriate for you.
Depending on the country you live in and your hospital, types of anaesthesia can include:
- General anaesthesia
- A local anaesthetic with or without sedation
You may be asked to give a urine sample before the procedure to test for a urinary tract infection.
Placing The Stent Using A Cystoscope
You will need to have a small procedure to have a stent placed in your body. A doctor will use a small camera called a cystoscope. This camera goes up your urethra into the bladder. The doctor finds the ureter and passes the stent through the camera. To remove the stent, a doctor will again use the cystoscope. Removing a stent is another small procedure. 8
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How To Prepare For Kidney Stone Surgery
When we meet with you, we will give you specific instructions to prepare for your surgery. They may include the following.
- Stop smoking, if you smoke, well in advance of surgery.
- Stop taking certain medications that can make it hard for your blood to clot, such as blood thinners like Coumadin, Plavix, Xarellto, and the like.
- Do not eat or drink anything after midnight prior to your surgery.
- Make sure you have someone to drive you home after your procedure.
We may also place a stent in your ureter up to a few weeks prior to your surgery. This stent, which is completely internal, allows your ureter to dilate or enlarge and makes stone removal easier. Stents may also relieve acute pain from a stone, enable any infection to drain, and allow antibiotic treatment before surgery.
How Is The Stent Removed
The stent is removed by having a small procedure called a Flexible Cystoscopy under a local anaesthetic. You may experience some discomfort and see blood in the urine following the procedure. Simple pain relief such as Paracetamol will help the discomfort. You are encouraged to increase your fluid intake to clear any blood in your urine and help prevent a urine infection.
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What Is The Best Sleeping Position
While doctors havent established a single best position for reducing stent-related discomfort when sleeping, there are some reports that people feel better sleeping on the opposite side where their stent is placed.
However, this isnt backed up by research. You may have to try different sleeping positions to determine how you can get more comfortable.
What Is A Ureteral Stent
Ureteral stents are small tubes inserted into the ureter to treat or prevent a blockage that prevents the flow of urine from the kidney to the bladder. The most common reason for ureteral stents is the treatment of kidney stones. Below are the answers to some of the questions we receive about ureteral stents.
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What Is Known To Date
Such patients are frequently encountered. Despite a lack of physiologic explanation as to why these non-obstructing stones may cause pain, there is emerging evidence that they do and therefore that removal can cure it.
In 2006 Taub et al. described outcomes of twenty such patients who had chronic flank pain as well as radiographically evident calcifications within their papillae without obvious collecting system stones. Ureteroscopy with laser papillotomy to unroof and remove all evident stone was performed on twenty seven kidneys. Pain improvement was seen in 85% of cases with a durable improvement for greater than one year in nearly 60% of cases.
This study was then repeated on a multi-institutional level with 65 patients undergoing similar procedures over a ten year period. Overall there were 176 procedures performed in this cohort with patients reporting less pain after the procedure 85% of the time. The mean duration of response was 26 months with 60% of patients having sustainable improvements in their pain levels for over one year.
Finally, this clinical scenario is seen commonly enough that it garnered its own nickname at Massachusetts General Hospital where it has been described as small stone syndrome. In a retrospective review of patients treated there with ureteroscopic removal of small nonobstructing stones for reasons related to chronic pain, 11/13 patients reported being pain free after the procedure with the other two noting a partial response.
What Happens To Patients
As a result, there is no standard of care regarding how to optimally manage such patients. In all cases it is first imperative to rule out other potential sources of pain however, such workups often end with the same result a patient with bothersome flank pain and evidence of one or more nonobstructing stones on imaging.
Lacking a physiologic explanation to explain their symptoms, patients with pain and non obstructing stones are often sent for detailed workups, secondary and tertiary consultations and referral to pain specialists and even psychiatrists. However, in an age where flexible ureteroscopy can be performed quite safely and on an outpatient basis one must wonder whether such patients are being treated appropriately.
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What Is Shock Wave Lithotripsy
Shock Wave Lithotripsy is the most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment. The stones are broken into tiny pieces. lt is sometimes called ESWL: Extracorporeal Shock Wave Lithotripsy®.
These are what the words mean:
- extracorporeal: from outside the body
- shock waves: pressure waves
So, SWL describes a nonsurgical technique for treating stones in the kidney or ureter using high-energy shock waves. Stones are broken into stone dust or fragments that are small enough to pass in urine. lf large pieces remain, another treatment can be performed
Stent Length And Positioning
Stent length seems to play a relevant role in stent-related symptoms since it is directly related to bladder irritation. Several different ways to assess the ideal stent length have been suggested.
Lee, et al. used a reference table in which a corresponding stent length was selected for each given specific height range. Ho, et al. prospectively evaluated 87 patients and assessed their stent-related symptoms. They determined that a 22-cm stent would be more appropriate for those whose height ranges from 149.5 cm to 178.5 cm with a median of 161.9 cm.
Mathematic formulas have also been proposed to calculate stent length. Hao, et al. used the following: or the vertical distance from the second lumbar vertebra to the pubic symphysis minus 2 cm. Hruby, et al. calculated that the xyphoid process to pubic symphysis distance as well as acromium process to the head of the ulna distance can both be used to predict double J length.
In the pediatric population, a rule of thumb has been proposed to determine the suitable JJ stent regardless of gender or size, which is simply to add 10 to the age of the patient . .
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When To See Your Doctor
Your doctor will probably schedule a follow-up appointment a week or two after removing a kidney stone. At this appointment, the doctor will make sure youre recovering as planned, and if you have a stent, it will probably be removed at this time. Always keep your follow-up appointments.
After kidney stone removal, complications may occur. Common complications include blood clots near the kidneys, nerve palsies, pancreatitis and obstruction caused by leftover kidney stone fragments. You should see a doctor if you suspect any of these complications. You should also see a doctor immediately if youre having trouble urinating, you have an increasing amount of blood in your urine, your pain is unmanageable, you have chest pain, you have a fever or youre vomiting.
Kidney Stent Side Effects
Kidney stent side effects are usually mild but can, in some cases, be severe. In the majority of patients, kidney stents are required for only a short period of time. This could typically range from a few weeks to a few months. When the underlying problem is not a kidney stone, the stent can stay in for several months.
While side effects are usually mild, a stent can sometimes be very uncomfortable.
How Long Will I Have A Ureteral Stent
Most ureteral stents are temporary. Your healthcare provider will perform another procedure to remove the stent after the kidney stone passes, infection clears up or other problems resolve. Youll probably have the stent for a few days or weeks.
Some people need stents for months or years. People who have tumors that press on the ureters or narrowed ureters may need ureteral stents for an extended time. Your provider will replace the stent with a new one every three to six months. Replacing the stent reduces the likelihood of complications.
What Happens After Bile Duct Stent Removal
After the procedure You need to lie on your right side for at least six hours to reduce the risk of bleeding. To ensure the proper functioning of the stent, you will be frequently assessed for changes in stool or urine color, jaundice, itching and abnormal liver functions, which indicates a narrowing of the bile duct.
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What To Expect Back Home
At hospital discharge, your doctor or nurse will give you instructions for rest, driving, and doing physical activities after the procedure.
Because surgical instruments were inserted into your urinary tract, you may experience urinary symptoms for some time after surgery. These symptoms usually disappear in a few weeks.
Symptoms may include:
- a mild burning feeling when urinating
- small amounts of blood in the urine
- mild discomfort in the bladder area or kidney area when urinating
- need to urinate more frequently or urgently
- pain resulting from an internal abrasion that needs time to heal
Try to drink fluids often but in small quantities. Sometimes a blood clot can cause pain . The urine contains a substance that will dissolve this clot.
If the pain remains despite the use of pain medication, contact the hospital or your doctor.
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How Is A Stent Performed
There are several ways to insert a stent.
Your doctor usually inserts a stent using a minimally invasive procedure. They will make a small incision and use a catheter to guide specialized tools through your blood vessels to reach the area that needs a stent. This incision is usually in the groin or arm. One of those tools may have a camera on the end to help your doctor guide the stent.
During the procedure, your doctor may also use an imaging technique called an angiogram to help guide the stent through the vessel.
Using the necessary tools, your doctor will locate the broken or blocked vessel and install the stent. Then they will remove the instruments from your body and close the incision.
Any surgical procedure carries risks. Inserting a stent may require accessing arteries of the heart or brain. This leads to an increased risk of adverse effects.
The risks associated with stenting include:
- an allergic reaction to medications or dyes used in the procedure
- breathing problems due to anesthesia or using a stent in the bronchi
- an infection of the vessel
- kidney stones due to using a stent in the ureters
- a re-narrowing of the artery
If you have bleeding issues, you will need to be evaluated by your doctor. In general, you should discuss these issues with your doctor. They can give you the most current information related to your personal concerns.
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What To Expect If You Receive An Ureteral Stent
A ureteral stent is most often used during the treatment of stone and occasionally with other surgery involving the urinary tract.
The experts at Georgia Urology have lots of experience in placing and removing stents, so check out our guide on this common medical procedure below.
What Are Ureteral Stents
Ureteral stents are thin, flexible tubes that hold ureters open. The ureters are part of the urinary system. Typically, these long, thin tubes carry urine from the kidneys to the bladder. Healthcare providers place ureteral stents to prevent or treat ureteral obstructions.
Silicone or polyurethane ureteral stents are about 10 to 15 inches long and about ¼ inch in diameter. They line the entire length of the ureter, keeping it open. The top part of the stent has a coil that sits inside a kidney. The loop at the lower end sits inside the bladder.
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Can I Take Out The Stent Myself
You should never attempt to remove a stent on your own, as more harm may be done than you might assume. This can include:
- Kidney, ureter, bladder damage or infection
- Severe pain
- Urinary retention
- Re-blockage of ureter with stone fragments not removed in original procedure leading to severe pain that will require another hospital/ER visit to replace stent
Stent Removal After Kidney Stone Laser
Similar to ureteral stones, kidney stones can be fragmented and removed with baskets. Occasionally, a kidney stone will fragment with a laser into very small. Jun 26, 2011 · In most patients, stent removal is a relief as their stent discomfort goes away. However, in some patients, severe pain may occur for several hours.
The stent is usually removed after a few days to a few weeks depending on the particular circumstances. Ureteric stents cannot stay in the body indefinitely (.
Following URS, clinicians may omit ureteral stenting in patients meeting all of the.
Index Patient 12: Adult, renal stone with pain and no obstruction.
The ureteral stent is typically removed in the office, usually within 1-2 weeks after the procedure but may be left for longer after complex procedures. If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4421. Dr. Alex Shteynshlyuger is a board certified urologist in NYC who.
If you have had a stent inserted after kidney stone surgery, it is temporary and only needed for a short period of time. There are two main methods for removal. For most patients, the stent will only stay in place for 5-7 days. Is a stent necessary after kidney stone removal? The routine placement of a ureteral catheter or stent following.
The stent removal does not hurt at all, I removed mine myself. The after effect of bladder spasms and kidney pain had me going back to the emergency room.
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How Is Ureteral Stent Placed
Urologists place stents at the time of surgery only. For this, they slide the stent on a soft wire and later on, place it over the ureter, which refers to a tube that drains into the kidney. During the end of surgical process, doctor places a stent within the ureter by the help of an X-ray or a scope. Stent in case of an adult is of 22cm to 30cm in length and it extends to the bladder from the kidney by using a coil on each end for holding the kidney stent in its place. Stent thus dilates the ureter to help in passing of the urine towards the bladder from kidney. In this case, doctors may leave an attached string to the kidney stent to remove it following surgery and may tap it to the stomach or leg.
Who Interprets The Results And How Do I Get Them
After the procedure is complete, the interventional radiologist will tell you whether the procedure was a success.
Your interventional radiologist may recommend a follow-up visit.
This visit may include a physical check-up, imaging exam, and blood tests. During your follow-up visit, tell your doctor if you have noticed any side effects or changes.
Side Effects And Symptoms After Stent Placement
Once a kidney stone stent is implanted, you can expect to notice some changes in your body, including some symptoms of discomfort as your body recovers after the stents placement.
Symptoms may include a frequent urge to urinate, which will likely decrease over time. The urge to urinate may come on suddenly, so patients receiving a ureteral stent should be mindful of their proximity to a bathroom in the days following the procedure. You may experience pelvic pain as your body recovers, and you may also notice blood in your urine at times while the stent is in place. This is usually not cause for alarm, although you can mention it to your doctor if youre concerned.