dr ajay prakash

Technique:
Ureteroscopy is highly successful procedure for the retrieval of stone in the ureter. It is passed through the normal urinary opening through the bladder into the ureter.
It involves the passage of an instrument namely Ureteroscope through normal urinary passage. The instrument is as thick as a pen and is about 40 cm long. The Ureterorenoscope is advanced under vision through the normal urinary passage under anesthesia. The Ureterorenoscope is advanced on the side of the stone and up to the stone. Once the stone is localized, various options are available. If the stone is small, it can be picked up by the forceps & pulled out. But, if the stone is larger, the stone can be broken into tiny fragments using Swiss lithoclast or ultrasound or even a combination of bothas in Swiss Lithoclast master. A variety of other instruments can be passed in through the scope, which can be used to break the stones and remove them. Patients have to be admitted in the hospital for a few days (2-3 days) for this procedure and it has to be done under anesthesia. Double J stent is usually kept post procedure to drain the kidney.
It is a very safe procedure in experienced hands and Ureterorenscopy can treat almost all the ureteric stones.

Therapeutic status of ESWL, PCNL, URS:
These techniques are not competitive with one another but are greatly complimentary to each other. Though ESWL is the ideal treatment for urinary calculi but in selected cases a combination of the above treatment modalities are much better off. Stones up to 2-2.5 cms. can be treated by introduction of Double – J stent and multiple sessions of ESWL therapy. However, stones larger than 2.5 cms or partial or complete stag horn will do better with a combination of PCNL and ESWL. PCNL can be used to debulk the stone mass and can be followed up with lithotripsy for residual fragments, if any are left behind. Impaction of stone fragments in lower ureter after lithotripsy may need URS. With the advancement of medical science and availability of these modalities, open surgery for the stone shall be rarely necessary. However, in certain selected cases, open surgery still remains the best modality of treatment.
Open surgery
With the advent of new technologies to treat stone disease, the need for open surgery has been drastically reduced. However, in some cases it might be required. The type of open surgery will depend upon the site and size of the stone within the urinary tract.
Interesting facts about urinary system.