Removal of Kidney Stones with a Flexible Ureteroscope

Univ.-Prof. Priv.-Doz. Dr. Mesut Remzi

Medical fields: Urology

Prof. Remzi, for which indications is the flexible ureteroscope used?

Ureteroscopy is a modern diagnostic and treatment method for the upper urinary tract, with which we can treat kidney and bladder stones in particular, and also more complex cases with the help of a laser. However, the ureteroscope can also be used to diagnose - and possibly treat (i.e. ablate) -urotelial carcinomas of the upper urinary tract (renal pelvic cancer). These rarely occur.

However, the incidence of stones within the urinary tract of the urogenital tract is very high and is around 10 % in Europe, with men being affected more frequently. Kidney stones often do not cause any symptoms, but colicky pain can occur if they detach from the kidney to travel through the ureter to the bladder.

How does a flexible ureteroscope work?

The ureteroscope is a very thin device with which you can easily pass through the ureter. Thanks to its flexibility, you can easily reach all regions of the kidney in order to view them or carry out the therapy. It consists of an optical light guide, a working channel and a flushing channel. The laser is introduced through the working channel, with which the stones are broken up and then extracted with a "stone basket", or in many cases completely crushed to dust.

To prepare for the operation, a urine culture and good imaging (usually CT) is necessary in order to be able to plan the operation well.

Is the method also suitable for larger kidney stones?

In principle, the method is also suitable for larger kidney stones, but not for so-called staghorn stones, i.e. extreme kidney stones in which the stone almost fills the entire renal pelvis.

What are the advantages over a rigid ureteroscope?

The big advantage is that you can penetrate all areas of the upper urinary tract with the flexible ureteroscope, which is not possible with the rigid one.

How is the anesthesia administered and how long is the hospital stay?

The procedure is performed under general anesthesia and takes about 60 minutes on average, depending on the size of the stone. The hospital stay depends on the indication and usually only lasts one night.

What has to be considered after the operation and how long does it take for the patient to recover?

Patients can usually leave the hospital the next day. For the operation itself, recovery lasts only a few hours. Depending on the indication, in some cases a splint must be placed in the ureter to facilitate the flow of urine to the bladder; this is removed again shortly after the operation.