Ureteroscopic lithotripsy (URSL) is a minimally invasive procedure used to treat stones located in the ureter or kidney. The procedure involves using a ureteroscope to visualize the stones and a laser or other device to fragment them into smaller pieces, making them easier to remove or pass naturally.
Indications for URSL
Ureteral Stones: Stones located in the ureter causing obstruction, pain, or infection.
Kidney Stones: Stones that have moved from the kidney into the ureter.
Recurrent Stone Formation: Patients with recurrent stones that have not been managed effectively with other treatments.
Procedure Overview
1. Preoperative Preparation
Patients are typically instructed to fast for several hours before the procedure.
Preoperative evaluation includes blood tests and imaging studies (e.g., CT scan or X-ray).
Antibiotics may be given to prevent infection.
2. Anesthesia
URSL is typically performed under general anesthesia to ensure patient comfort and immobility during the procedure.
3. Procedure Steps
Insertion: The patient is placed in a lithotomy position (lying on the back with legs raised and supported). A ureteroscope (either flexible or rigid) is inserted through the urethra into the bladder and then advanced into the ureter.
Stone Localization: The ureteroscope is used to visually locate the stone.
Fragmentation: A laser fiber (commonly a holmium laser) is introduced through the ureteroscope to fragment the stone into smaller pieces. Other mechanical devices or ultrasound probes can also be used.
Removal: Stone fragments are either removed using a basket or left to pass naturally in the urine.
4. Stent Placement
A temporary ureteral stent (a small tube) may be placed to ensure urine flow and reduce ureteral swelling after the procedure. This stent is usually removed after a few days to a few weeks.
Advantages of URSL
Minimally Invasive: No external incisions, leading to faster recovery and less pain compared to open surgery.
High Success Rate: Effective in fragmenting and removing ureteral stones
Quick Recovery: Most patients can resume normal activities within a few days.
Recent Advances in URSL
Holmium Laser Lithotripsy: The standard laser for stone fragmentation due to its effectiveness and safety profile.
Thulium Fiber Laser: A newer technology offering precise control and less retropulsion of stone fragments.
Digital Ureteroscopes: Provide high-definition visualization, improving the accuracy of stone treatment and reducing the risk of complications.
URSL is a key procedure in the management of ureteral and kidney stones, offering a minimally invasive, highly effective solution with a quick recovery time. Its precision and success rate make it a preferred option for urologists and patients dealing with urinary tract stones.
