16254 Nephroscopy

Overview

Nephroscopy is a procedure that lets a doctor look directly inside one of your kidneys using a thin tube with a tiny camera at the tip. The word comes from 'nephro' (kidney) and 'scopy' (looking). The tube goes in either through your urine tube and bladder, or through a small keyhole opening in your back. It is done in hospital, under an anaesthetic, so you will not feel pain while it happens. Nephroscopy is often used to find the cause of a kidney problem and to treat it in the same session — for example, removing a kidney stone.

Nephroscopy is a specialist procedure carried out by urology teams (the doctors and nurses who look after the kidneys, bladder and urinary system). It is not an everyday test like a blood test, but it is a well-established and routine procedure in specialist centres.

It can be needed at any age, but it is most often used in adults who have kidney stones, blood in their urine, a suspicious area seen on a scan, or a narrowing in the tube that drains the kidney. It is used less often in children, and only by specialist teams.

Symptoms

Common symptoms

• Blood in your urine (pee), which may look pink, red or cola-coloured
• Pain in your side or lower back, just below the ribs, sometimes spreading to your tummy or groin
• Repeated urine infections, or burning when you pass urine
• Feeling sick or generally unwell alongside the pain
• A kidney stone or an unusual area in the kidney seen on a scan, even if you feel fine

Symptoms in children

• Pain in the tummy or side that a child may find hard to describe, or that comes and goes
• Blood in the urine, or urine that looks cloudy or smells strong
• Fever, irritability, poor feeding or being more sleepy than usual
• Wetting the bed again after being dry, or going to the toilet much more often

Symptoms in older adults

• Blood in the urine is a more common reason for tests in older adults
• Confusion or sudden drowsiness can be a sign of a urine or kidney infection
• Vague tiredness or loss of appetite rather than clear pain
• Other health conditions may affect which anaesthetic and procedure are safest for you

Causes

Main causes

• Kidney stones that are large, awkward in shape or position, or that have not cleared with other treatments
• Blood in the urine where scans have not shown a clear reason
• An unusual-looking area in the kidney seen on a CT scan or ultrasound, which needs a closer look or a small sample
• A narrowing (stricture) in the tube that drains urine from the kidney, which can be stretched or held open
• Follow-up checks after certain kidney treatments or surgery

Risk factors

• Having had kidney stones before, or a family history of stones
• Not drinking enough fluids, especially in hot weather or with physical work
• A diet high in salt, or low in fruit and vegetables
• Being overweight
• Some long-term medical conditions, such as diabetes or problems with the kidneys' drainage
• Previous surgery or injury to the kidney or urinary system

When to see a doctor

See a doctor urgently if:

• You notice blood in your urine
• You have a high temperature with pain in your side or back
• You have severe pain that comes in waves and does not settle with your usual pain relief
• You are passing very little urine, or feel dizzy and unwell

Book a routine appointment if:

• You keep getting urine infections
• A kidney stone or kidney change has been found on a scan and you want to talk about options
• Your doctor has suggested nephroscopy and you would like to understand the benefits, risks and alternatives
• You have ongoing twinges or discomfort in your side that you would like checked

Diagnosis

Before any nephroscopy, your doctor will talk with you about your symptoms, examine you, and arrange blood and urine tests and scans. These build a picture of what is happening in your kidney. Nephroscopy itself is then used to see the inside of the kidney directly and to confirm what is going on — sometimes it is the only way to be certain.

Tests that may be done

• Urine tests, including a dipstick test in the clinic and a laboratory test to check for infection
• Blood tests to check how well your kidneys are working and to plan for anaesthetic
• A CT scan or ultrasound scan of your kidneys, which shows stones and the shape of the kidney
• Sometimes a cystoscopy, which is a quick look inside your bladder before the kidney is reached
• During nephroscopy, a small sample of tissue may be taken and sent to the laboratory for checking

What to expect at your appointment

You will usually be asked to stop eating for a few hours before the procedure — your team will tell you the exact times. You will meet the anaesthetist beforehand. The procedure itself usually takes between about 30 minutes and an hour and a half, depending on what is found and treated. You will wake up in a recovery area. You may have a thin, soft tube (a catheter) to drain urine, and possibly a small drain tube from your back if the kidney was reached through the skin. It is common to see some blood in your urine for a day or two. Most people go home the same day or the next day.

Treatment

Nephroscopy is used both to find problems and, very often, to fix them at the same time. How it is done depends on why you need it and where in the kidney the problem lies. Your team will explain the plan and the alternatives before you decide.

Self-care at home

• Drink plenty of fluids after the procedure, as your team advises — this helps flush the kidney and eases soreness
• Take any pain relief your team recommends, and follow the instructions on your discharge sheet
• Keep any small wound or drain site clean and dry, and follow the dressing advice you are given
• Avoid heavy lifting, straining and strenuous exercise for the time your team advises — often about one to two weeks
• Watch for fever, worsening pain, heavy bleeding or feeling unwell, and contact your team or urgent care if these happen
• Attend any follow-up appointment so your team can check how you are healing

Medical treatments

There are two main ways to reach the kidney. In the first, the doctor passes a thin, flexible tube up through your urine tube and bladder and into the kidney — this leaves no cuts on the outside. In the second, a small keyhole opening is made in the skin of your back to reach the kidney directly; this is used for larger stones. If a stone is found, the team can often break it into tiny pieces using a special energy device and remove the pieces during the same session. If the drainage tube is narrowed, it can be gently stretched, and a small soft tube (a stent) may be left inside for a while to keep it open. A small growth can be sampled or removed. Your team may also give you medicine to help prevent infection. You will be told exactly what was found and done before you go home.

When is surgery considered?

Nephroscopy is itself a procedure, so the question is which type is right for you. The 'through the urine tube' route is usually chosen for smaller stones or for looking around. The 'keyhole through the back' route is usually chosen for larger or harder stones, or when the kidney needs a more direct approach. Sometimes your team may suggest a different treatment entirely, such as shock-wave treatment for a stone, or simply monitoring a small finding. These choices depend on your kidney's shape, your general health and your own preferences.

Living with this condition

Most people recover quickly. You may feel tired for a few days and notice a little blood in your urine now and then, which usually settles. If a stent has been left in place, you may feel a mild ache in your side or need to pass urine more often — this usually eases once the stent is removed. Take things gently at first and build up as you feel able.

Lifestyle tips

• Keep drinking regularly through the day so your urine stays pale
• Cut back on salt, and on very salty processed foods
• Stay active — gentle walking is fine soon after the procedure, then build up
• Keep a note of any symptoms that change, so you can tell your team
• Go to your follow-up appointments, and ask questions if anything is unclear

Diet and exercise

Once you feel ready, gentle exercise such as walking is good for you and helps your recovery. Wait until your team says it is safe before returning to heavy lifting, contact sports or strenuous gym work. If a stone was found, your team may suggest diet changes — for example, drinking more water, eating less salt and eating plenty of fruit and vegetables. A dietitian can give you personalised advice if you would like it.

Mental health and emotional wellbeing

It is completely normal to feel anxious before a hospital procedure, or to feel worn out afterwards. Worry can affect your sleep and appetite. Writing down your questions beforehand, and asking someone to come with you to appointments where possible, can help you feel more in control. If low mood or worry is lasting or getting in the way of daily life, tell your doctor — support is available, and you deserve it.

Prevention

You cannot always prevent the kidney problems that lead to nephroscopy, but there is a lot you can do to lower the chance of kidney stones coming back. Drinking enough fluid every day is the single most helpful step, along with eating less salt and keeping to a healthy weight.

Screening programmes

There is no routine screening test for kidney stones for most people. If you have had stones before, or you have a condition that makes stones more likely, your team may suggest regular check-ups or scans. Ask your doctor whether follow-up is right for you.

Complications

If left untreated

• A large kidney stone can block the flow of urine, which may cause infection or gradually damage the kidney
• A kidney infection can become serious and, rarely, spread through the body
• A narrowing in the kidney's drainage tube can slowly harm kidney function if it is not treated
• Blood in the urine with no clear cause may hide a growth that is better found early
• The procedure itself has small risks, including bleeding, infection, discomfort, or injury to the tube that carries urine from the kidney — your team will discuss these with you

Long-term outlook

For most people the outlook is very good. Nephroscopy is a well-established procedure, and many kidney problems can be found and treated in a single session. Recovery is usually quick, and most people are back to their usual activities within days to a couple of weeks. Your team will tell you what they found and what follow-up, if any, you need.

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