Ureteroscopy With Laser Lithotripsy

Ureteroscopy with laser lithotripsy is a minimally invasive procedure used to vaporize kidney stones using concentrated light – laser energy. It is often used for kidney stones that have failed to pass and have become lodged in the ureter. Because blockage of the ureter causes backflow of urine in the kidney and consequent swelling and distension, patients can experience significant pain.

This modality for kidney stone removal begins by threading a flexible or rigid ureteroscope up the urethra through the bladder and into the ureters. A small high-definition camera helps the urologist visualize the trapped kidney stone.

The high-intensity, focused laser is deployed to vaporize the kidney stone. Because we can visualize the stones, this is an excellent method for getting patients entirely stone free. Further, laser lithotripsy works whether the stone composition is calcium-based or otherwise (Uric acid, struvite, or cystic).

Stenting After Laser Lithotripsy

Stenting is an integral part of the recovery process after a ureteroscopy with laser lithotripsy. Stents are temporary plastic tube-like structures inserted into the ureter between the bladder and the kidney. The goal is to keep the ureter open after laser lithotripsy, which almost invariably causes some swelling and inflammation due to the stone and the subsequent treatment. The stent is placed while the patient is under anesthesia and is removed about a week later during a simple procedure known as a cystoscopy.

The concept of a stent being left within the body, albeit temporarily, is a point of consternation for many patients. However, it’s important to note that about 80% of patients will tolerate these stents quite well. Some bladder irritation and pain are to be expected. Blood in the urine is almost ubiquitous. These concerns will clear up after the stent is removed. A small number of patients may experience slightly worse but ultimately tolerable symptoms. In contrast, a tiny percentage – maybe 5% or so – will experience symptoms that are significant enough that these stents may need to be removed sooner.

The Choice Between ESWL and Laser Lithotripsy

If you have researched kidney stones, you will have likely come across a noninvasive procedure known as extracorporeal shockwave lithotripsy, also known as ESWL, which uses targeted shockwaves to break up calcium-based kidney stones. This is often the preferred kidney stone treatment method for patients because it does not involve incisions or inserting a scope through the urethra. However, ureteroscopy with laser lithotripsy offers a virtually 100% stone-free rate. The urologist can visualize the kidney stone and ensure it is broken into small enough pieces to pass through the urinary system. The decision to have one procedure or the other will be based upon a consultation with your urologist.

The Risks and Considerations of Ureteroscopy With Laser Lithotripsy

Because this is not a surgical procedure and uses the patient’s existing anatomy to guide the scope, the results are excellent, with few significant risks. Risks can include pain, infection, and bleeding. Rarely, ureteral injury or perforation, as well as a stricture caused by scarring of the ureter, are possible. These risks can be mitigated by employing a urologist with significant experience. Regardless of the procedure, patients should be aware of fever afterward. Fevers are problematic and can eventually lead to bacteremia and potentially sepsis if left untreated. Any fever should be reported to our office immediately, and if you cannot reach a specialist right away, a visit to the emergency room is warranted.

Early management of kidney stones is crucial to effective treatment and avoidance of urinary issues, including kidney failure. Be sure to contact a urologist, such as those at Georgia Urology, to get an appointment for treatment and relieve the often significant pain associated with stones. Our stone hotline is available 24 hours a day for appointments. We are often able to see stone patients the same or the next business day.