Introduction
A ureteroscopy is both a diagnostic and therapeutic procedure whereby a small camera is placed into the bladder through the urethra and into the ureter up to the kidney to inspect the upper urinary tract. Once in the ureter or kidney, a number of different instruments can be passed through the ureteroscope to treat a number of different conditions.
Indications
A cystoscopy can be performed to investigate and possibly treat the following:
- Kidney or ureteric stones.
- Haematuria.
- Recurrent urinary tract infections.
- Abnormal urine cytology.
- Ureteric or kidney tumours.
- The presence of foreign bodies.
- Ureteric strictures.
Preoperative Instructions
A urine test will be performed prior to the procedure to ensure there is no active urinary tract infection. An active infection will often require treatment prior to a ureteroscopy. A ureteroscopy can be performed even when the patient is taking medications that increase the risk of bleeding such as warfarin, clopidogrel, apixaban and rivaroxaban, however these will often be stopped a number of days prior to the procedure to reduce the risk of bleeding. A number of other tests such as an ultrasound or CT scan and urine cytology may also be performed prior to a ureteroscopy.
Procedure
A ureteroscopy can be performed with either a flexible or a rigid ureteroscopy. A flexible ureteroscope allows all areas of the inside of the kidney to be inspected and therefore provides the options to treat conditions in difficult to access areas of the kidney. A rigid ureteroscope is most useful for treating conditions that affect the ureter. Both procedures usually follow a cystoscopy and are performed under general anaesthetic only.
Postoperative Instructions
In the first 24-48 hours following a ureteroscopy the patient may experience some burning and stinging whilst urinating along with some abdominal pain in the side if the procedure. They may also notice some blood in the urine for up to a week. The patient is able go about their regular duties following a ureteroscopy.
Risks
The risks of a cystoscopy include:
- Bleeding.
- Infection.
- Dysuria.
- Ureteral stricture.
- Ureteric injury.
- Abdominal pain.