Ureteroscopic Surgery is a very safe surgery performed with minimal invasion to treat stone formation diseases in the ureter and kidneys of the human body. Doctors use this surgery for primary treatment as well as subsidiary treatment after having tried out other options. This surgery has high chances of success but often results in the patient having to stay longer in the hospital and suffering from complications. Ureteroscopic surgery is also an effective way of treating pregnant ladies and paediatric patients. The doctors in Jehangir Hospital, Pune are very experienced in performing surgeries like this. The hospital also provides efficient clinical examination facilities.
Types of Uteroscopy
1. Diagnostic endoscopy
In diagnostic endoscopy the image of the ureter is taken with the help of an ureteroscope and a guidewire without putting the upper urinary tract under trauma.
2. Therapeutic treatment
Therapeutic treatment is used for a variety of complications like stricture disease, treating stones and urothelialtumours.
Pre-operative details:
• Before the ureteroscopic examination of the patient, the surgeon needs to have all the required instruments ready.
• The instruments include – accessories, endoscopes, sources of energy and fluoroscopy.
• The energy sources can be any of the following – Electrocautery, Mechanical impactor and electrohydraulic lithotripsy.
• The doctor administers a dose of broad spectrum antibiotic which is parenteral in nature, prior to the operation.
• In most cases fluoroquinolone or cephalosporin is utilized as the antibiotic.
Intra-operative details:
• During the ureteroscopy a guide wire is essential for safety purposes.
• This guide wire helps in passing the ureteroscope several times into the ureter during the surgery.
• A gasper with multiple prongs is required to collect the fragments during the several times the endoscope is passed.
• In such cases, a ureteral sheath is used to give a protective covering to the intra-mural ureter and the ureteral meatus. This prevents trauma in those parts of the body.
Post-operative details:
• At the end of the ureteroscopic surgery, doctors place stents inside the ureter so that the healing process takes place faster and to make sure that proper drainage takes place, in case a lot of manoeuvres had taken place during the operation.
• The stents might cause an increase in the frequency of urination and may also cause hematuria.
• The stents maybe removed after a few weeks or 6-8 weeks depending upon the degree of healing that takes place.
• The patients are discharged the very same day on which the operations are performed.
• The patients are given analgesics and antibiotics to prevent infection.
• Proper positioning and careful selection of the stents make sure that the unpleasant side-effects do not take place.
Follow-up procedure:
• After the surgery is performed successfully, the patients need to visit the doctor to remove their stents.
• The imaging process needs to be repeated at intervals for a number of months after the operation to see the progress of the surgery.
Complications:
• Minor complications –Some of the minor complications that take place are colic pain, false passage, fever and hematuria. These complications are found in a very small percentage of patients and are not serious.
• Major complications - Some of the major complications taking place are perforation, avulsion, stricture, Urinoma, urosepsis, deep vein thrombosis and cardiovascular accidents. These are also found in a handful of patients but require serious treatment.
Prognosis:
• In case of diagnostic ureteroscopy, if the source of bleeding is found or if the nature of defect is ascertained, then the treatment is brought to an end.
• In case of therapeutic ureteroscopy, the obstruction in the ureter must be resolved and the burden of the stone must be decreased. The drainage should be improved by endoscopic stricture.
All the processes related to ureteroscopic surgery are performed with expertise at Jehangir Hospital, Pune.
Types of Uteroscopy
1. Diagnostic endoscopy
In diagnostic endoscopy the image of the ureter is taken with the help of an ureteroscope and a guidewire without putting the upper urinary tract under trauma.
2. Therapeutic treatment
Therapeutic treatment is used for a variety of complications like stricture disease, treating stones and urothelialtumours.
Pre-operative details:
• Before the ureteroscopic examination of the patient, the surgeon needs to have all the required instruments ready.
• The instruments include – accessories, endoscopes, sources of energy and fluoroscopy.
• The energy sources can be any of the following – Electrocautery, Mechanical impactor and electrohydraulic lithotripsy.
• The doctor administers a dose of broad spectrum antibiotic which is parenteral in nature, prior to the operation.
• In most cases fluoroquinolone or cephalosporin is utilized as the antibiotic.
Intra-operative details:
• During the ureteroscopy a guide wire is essential for safety purposes.
• This guide wire helps in passing the ureteroscope several times into the ureter during the surgery.
• A gasper with multiple prongs is required to collect the fragments during the several times the endoscope is passed.
• In such cases, a ureteral sheath is used to give a protective covering to the intra-mural ureter and the ureteral meatus. This prevents trauma in those parts of the body.
Post-operative details:
• At the end of the ureteroscopic surgery, doctors place stents inside the ureter so that the healing process takes place faster and to make sure that proper drainage takes place, in case a lot of manoeuvres had taken place during the operation.
• The stents might cause an increase in the frequency of urination and may also cause hematuria.
• The stents maybe removed after a few weeks or 6-8 weeks depending upon the degree of healing that takes place.
• The patients are discharged the very same day on which the operations are performed.
• The patients are given analgesics and antibiotics to prevent infection.
• Proper positioning and careful selection of the stents make sure that the unpleasant side-effects do not take place.
Follow-up procedure:
• After the surgery is performed successfully, the patients need to visit the doctor to remove their stents.
• The imaging process needs to be repeated at intervals for a number of months after the operation to see the progress of the surgery.
Complications:
• Minor complications –Some of the minor complications that take place are colic pain, false passage, fever and hematuria. These complications are found in a very small percentage of patients and are not serious.
• Major complications - Some of the major complications taking place are perforation, avulsion, stricture, Urinoma, urosepsis, deep vein thrombosis and cardiovascular accidents. These are also found in a handful of patients but require serious treatment.
Prognosis:
• In case of diagnostic ureteroscopy, if the source of bleeding is found or if the nature of defect is ascertained, then the treatment is brought to an end.
• In case of therapeutic ureteroscopy, the obstruction in the ureter must be resolved and the burden of the stone must be decreased. The drainage should be improved by endoscopic stricture.
All the processes related to ureteroscopic surgery are performed with expertise at Jehangir Hospital, Pune.
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