Rigid, Flexible Ureteroscopy and Percutaneous nephrolithotomy, Stone Surgery

Rigid and/or Flexible ureteroscopy involves the passage of special fine bore endoscopes into the ureter. The indications for these procedures could be diagnostic or therapeutic. The commonest indication is therapeutic ureteroscopic vapourization, fragmentation and removal of urinary stones using a holmium-YAG laser. Typically, a cystoscopy is first performed followed by access into the ureter after the passage of a safety guidewire under X-ray control. Continuous visualization is maintained with the use of irrigating fluid.

Ureteroscopy is a safe and minimally invasive method of treating stone disease in the kidneys and ureter. 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. The success rate of stone treatment depends on the size and location of the stones but is typically above 90%. At the end of the procedure a temporary drainage tube (catheter or stent) is usually inserted into the ureter. A catheter may also be placed into the bladder also for temporary urine drainage and output monitoring.

The commonest indication for this procedure is kidney stones larger than 2cm in diameter. Percutaneous surgery is based on needle and guidewire access to the kidney and the upper urinary tract. Once guidewire access is obtained, special catheters can then be placed into the kidney, either for drainage or for facilitation of antegrade intrarenal or ureteral endoscopic procedures. A tract must first be established and should provide a straightforward route to the kidney, allowing bloodless instrumentation. A nephroscope is then used to visualize the collecting system of the kidney. Stones can be fragmented with ultrasonic or pneumatic lithotripsy. At the end of the procedure, a drainage tube is left in the kidney as well as a catheter in the bladder to allow urine output monitoring. The success rate of stone treatment depends on the size and location of the stones but is typically above 90%. Occasionally secondary or repeat procedures are required.