Ureteroscopy

Ureteroscopy

Ureteroscopy is an examination of the upper urinary tract, usually performed with a ureteroscope that is passed through the urethra and the bladder, and then directly into the ureter; usually the lower 2/3 of the ureter is accessible by this procedure.

 

Surgical Therapy

Ureteroscopy can be divided into diagnostic endoscopy and therapeutic treatments.

  • •Diagnostic ureteroscopyAtraumatic diagnostic endoscopy minimizes mucosal distortion, allowing for complete mapping of the upper urinary tract. Ureteroscopic access is obtained with a wireless technique, if possible. The ureteral orifice is visualized and intubated without the assistance of a guidewire. The intramural ureter is traversed employing a “no-touch” technique, and the more proximal ureter and renal collecting system are then mapped. In a recent prospective study of 460 consecutive upper-tract endoscopies, no-touch ureteroscopy was successfully performed in most patients without prior stenting or ureteral dilation. [5] This wireless form of flexible ureteroscopy eliminates the potential trauma, mucosal irritation, and inadvertent manipulation of stones or tumors caused by guidewires and is particularly helpful when the collecting system is evaluated for mucosal/intra-luminal lesions.
  • • Therapeutic ureteroscopyTherapeutic ureteroscopy is used in varied applications, including in the treatment of stones, urothelial tumors, and stricture disease. Ureteroscopy is a safe and minimally invasive method of treating stone disease in the kidneys and ureter as shown below. It can be used either as primary therapy or as salvage therapy for residual stones following treatment with other modalities such as extracorporeal shockwave lithotripsy (ESWL) and/or percutaneous nephrolithotomy (PCNL). Compared with ESWL, ureteroscopic lithotripsy achieves a greater stone-free state. [6] Success rates following ureteroscopy are shown in Table 2 and Table 3 in the Outcome and Prognosis section below.

 

Ureteroscopy is defined as upper urinary tract endoscopy performed most commonly with an endoscope passed through the urethra, bladder, and then directly into the upper urinary tract. Indications for ureteroscopy have broadened from diagnostic endoscopy to various minimally invasive therapies. Technological advancements have led to broader indications while minimizing peri-operative complications resulting in efficacious access to the upper tract.