16213 Ureteroscopy

Overview

A ureteroscopy is a procedure that lets a doctor look inside your ureter and, if needed, your kidney. Your ureters are the two narrow tubes that carry urine from each kidney down to your bladder. The doctor uses a ureteroscope: a very thin, bendy tube with a tiny camera and light on the tip. It is passed up through the opening you pass urine from (the urethra), into your bladder, and then up into the ureter. There are no cuts on the outside of your body. The doctor can see the area on a screen, take small samples of tissue if needed, and often treat the problem at the same time — most commonly by breaking up and removing a kidney stone.

Yes. Ureteroscopy is a very common and well-established procedure. Many hospitals do several every week, and doctors have a lot of experience with it.

It is most often done in adults who have a kidney stone stuck in the ureter or a stone in the kidney that needs removing. It can also be used to check an area that looked unusual on a scan, to find the cause of blood in the urine, or to widen a narrowed ureter. Children can have it too, but this is less common and is done in specialist children's centres.

Symptoms

Common symptoms

• Sharp pain in your back or side, often coming in waves (doctors call this renal colic)
• Blood in your urine, which may look pink, red or cola-coloured
• Feeling sick or being sick
• Needing to pass urine more often, or a burning feeling when you go
• A dull ache in your lower tummy or groin as a stone moves down
• Fever, if there is also an infection

Symptoms in children

• Tummy pain rather than back pain, which is more common in young children
• Being sick or refusing to eat
• Blood in the urine or nappies
• Being irritable or generally unwell with no clear reason
• Children with suspected stones should be seen by a specialist children's team

Symptoms in older adults

• Pain may be vague or milder than expected, or there may be no pain at all
• Confusion or feeling generally unwell can be the main sign, especially if there is an infection
• Blood in the urine may be the only noticeable sign
• There may be more focus on checking whether the anaesthetic and other health conditions are safe for you

Causes

Main causes

• Kidney or ureter stones — the most common reason for this procedure. Stones form when waste chemicals in urine clump together into hard crystals.
• A narrowed or scarred ureter (called a stricture), which can slow the flow of urine
• An unusual area seen on a scan that needs to be looked at and possibly sampled
• Blood in the urine where other tests have not found the cause
• Problems with a stent or tube that is already in place
• Less often, an abnormal growth in the lining of the kidney or ureter that needs checking

Risk factors

• Having had kidney stones before
• A family history of stones
• Not drinking enough fluids, especially in hot weather or with physical work
• A diet high in salt or in animal protein
• Being overweight
• Some long-term health conditions, such as gout, diabetes or problems with how the kidneys handle certain chemicals
• Repeated urine infections or an unusual shape to your urinary system
• Some prescription medicines can raise the risk — ask your doctor or pharmacist whether any of yours could play a part

When to see a doctor

See a doctor urgently if:

• Fever with shivering or shaking chills, especially alongside back or side pain
• Severe pain that is not controlled by the pain relief you have been advised to use
• Being unable to pass urine
• Being sick and unable to keep fluids down
• Heavy or worsening blood in your urine

Book a routine appointment if:

• Blood in your urine, even once and even if it clears up
• Repeated twinges of back or side pain that you cannot explain
• A history of stones and new symptoms
• Burning or discomfort when passing urine that keeps coming back
• Questions or worries about a ureteroscopy you have been offered

Diagnosis

The team will first talk with you about your symptoms, examine you, and arrange tests to see what is going on. Ureteroscopy itself is both a way of looking directly at the problem and a way of treating it. If your doctor suggests it, it is usually because a scan has already shown something that needs attention — most often a stone that is unlikely to pass on its own, or an area that needs a closer look.

Tests that may be done

• A urine test to check for blood and infection
• Blood tests to check how well your kidneys are working and to look for infection
• A CT scan of your tummy and pelvis — this is the most detailed way to find a stone and see exactly where it is
• An ultrasound scan, which is often used first, especially in children and pregnant women
• A plain X-ray in some cases, depending on the type of stone
• A chest X-ray or heart tracing (ECG) before an anaesthetic, if needed
• During the procedure, small samples of tissue may be taken and sent to a lab for testing

What to expect at your appointment

You will usually be asked not to eat for several hours before the procedure. Most people have it as a day case or with one night in hospital. You will meet the anaesthetic team first. The procedure is done under a general anaesthetic or a spinal anaesthetic, so you will not feel pain. Afterwards you may have a thin tube in your bladder for a short time, and you may notice blood in your urine and some discomfort when passing urine for a day or two. Your team will explain the plan for your particular case clearly before you agree to go ahead.

Treatment

Ureteroscopy is a treatment as well as a look. Using fine instruments passed through the scope, the doctor can break a stone into tiny pieces using a laser or another energy source, then remove the pieces or leave them to pass. They can also widen a narrowed area, take a small sample of tissue, or place a stent — a soft, thin tube that keeps urine flowing while you heal. Your team will talk you through the specific plan for you, including the small risks of the procedure and how they will be managed.

Self-care at home

• Drink plenty of water in the days after your procedure — this helps flush the urinary system and ease discomfort. Your team will tell you how much is right for you.
• Take the pain relief your team advises if you need it. Follow the label and ask a pharmacist if you are unsure.
• Rest for the first day or two, then build up gently. Avoid heavy lifting or strenuous exercise for about a week or until your team says it is fine.
• You may see a little blood in your urine, and it may sting when you go. This usually settles within a few days.
• If you have a stent, you may feel a dull ache in your back or need to pass urine more often. Mention it to your team — it is common and can usually be eased.
• Finish any course of treatment your team prescribes, even if you feel better, and keep any follow-up appointments.
• Note down any questions as they come to you, so you remember to ask at your review.

Medical treatments

Alongside the procedure, your team may suggest medicines to prevent or treat infection, medicines to ease pain, and sometimes medicines to help relax the ureter or help small stone fragments pass. They may also suggest changes to help prevent new stones forming. Which options suit you depends on your test results and your other health conditions, so this is a conversation to have with your doctor or pharmacist rather than something to decide alone.

When is surgery considered?

Ureteroscopy may be advised when a stone is too big to pass, is causing severe pain, is blocking the kidney, or is linked with an infection that needs clearing. It may also be suggested when a scan shows something that needs to be looked at directly, when a ureter is narrowed, or when blood in the urine needs investigating. Some people choose to wait and see whether a small stone passes by itself — your doctor can explain the pros and cons for your situation.

Living with this condition

Most people are back to normal daily activities within a few days to a week. You may feel more tired than usual at first, and you may need to pass urine more often, especially if a stent is in place. Plan a gentler week than usual, keep water with you, and give yourself permission to rest when your body asks for it.

Lifestyle tips

• Keep your urine pale straw-coloured by drinking water regularly through the day
• Cut back on salt and on very salty processed foods
• Eat a balanced diet with plenty of fruit and vegetables
• Stay active — gentle walking is fine soon after the procedure, and regular activity helps overall
• Go for a wee when you feel the urge rather than holding on
• Follow any advice your team gives about the amount and type of fluid that suits you

Diet and exercise

Your team may suggest a diet plan based on the type of stone you had — for example, cutting back on salt, or adjusting how much of certain foods you eat. Ask whether a referral to a dietitian would help. Exercise is encouraged: build back up gradually, avoid heavy lifting for about a week, and choose something comfortable like walking or swimming once you feel ready.

Mental health and emotional wellbeing

Kidney stone pain can be frightening, and waiting for a procedure can make anyone anxious. It is completely normal to feel worried, fed up, or worn down by it. Most people feel much better once the problem is treated. If worry is affecting your sleep, appetite or mood, tell your doctor — this is a common and treatable part of the experience, not something you have to push through alone.

Prevention

You cannot always prevent the problems that lead to a ureteroscopy, but you can lower your chance of new kidney stones forming. Drinking enough water every day is the single most helpful step for most people. Cutting back on salt, eating a balanced diet and staying active also help. If you have had a stone, ask your doctor whether your stone was tested and whether any specific diet or follow-up checks would be useful for you.

Screening programmes

There is no routine screening programme for kidney stones. If you have had stones before or have a strong family history, your doctor may suggest occasional check-ups or tests. Ask what would be sensible in your case.

Complications

If left untreated

• A stone that blocks the ureter can cause severe pain that keeps coming back
• Urine can build up behind the blockage and put pressure on the kidney
• An infection can develop in trapped urine, which can become serious quickly
• Repeated or long-standing blockage can damage the kidney over time
• Blood in the urine that is not checked may mean a treatable cause is missed

Long-term outlook

The outlook is generally very good. Ureteroscopy is a well-tested procedure and most people recover well, with their symptoms improving once the stone or other problem is dealt with. As with any procedure there are small risks — such as infection, bleeding, or irritation from a stent — and your team will explain these and how they are managed. Most people are back to normal life within about a week, and many feel better than they have in weeks. If anything worries you afterwards, contact your team early rather than waiting.

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