The greatest advantage of Rigid Ureteroscopy URS (Breaking Kidney Stone) is the ability to break the kidney stone with no need to make a surgical incision.
Since breaking kidney stone in the ureter with the Rigid Ureteroscopy procedure involves no incision, patients are discharged the same day. Patients return their daily life within 3 days after the procedure.
Patients with any of the following conditions are not suitable candidates for Rigid Ureteroscopy:
- Bleeding problems
- Orthopedic disorder in the legs
- Urinary tract infection
What is Rigid Ureteroscopy?
Rigid ureteroscopy is an endoscopic (closed) surgery performed in the ureter by accessing it through the urethral orifice, with the intent to break kidney stones. This procedure involves no surgical incision to be made on the patient's body. During the procedure, an approximately 100 cm long instrument called a rigid ureteroscope is used. This tool is too hard that cannot be bent.
With the ureteroscope, stones located close to the urinary bladder can be treated, as well.
How is the Surgical Procedure Performed?
Kidney stone-breaking operations in the ureter are performed under general or spinal/epidural anesthesia. After the anesthesia procedure, the patient is placed in the supine delivery position.
A rigid ureteroscope is inserted through the patient’s urethral orifice. After accessing the bladder, a guidewire is delivered to the pathway (ureter) that connects the kidneys and the bladder to each other. After the guidewire reaches the kidney, the ureter is accessed with the help of this wire, and the stone is reached. The stone is then broken using power sources with percussive (pneumatic) or laser systems, which can pass through the ureteroscope.
If the pieces of the broken kidney stone are small in size, they are left in their places, and the patient discharges them from the body in normal ways. Relatively large pieces of stone are taken out of the body with the help of tools called baskets.
At the end of the procedure, a double-J catheter (DJ catheter) is inserted between the kidney and bladder, depending on the need.
Postoperative Period
If no problem is observed approximately 5 hours after the rigid ureteroscopy, the inserted catheter is removed and the patient is then discharged. However, the period before the discharge of the patient may be 18-24 hours, depending on the difficulty level of the operation.
If a double-J catheter has been inserted at the end of the operation; it is removed with the aid of cystoscopy 1-6 weeks after the operation, depending on the reason for its insertion. The inserted catheter can remain in the patient's body for a period of a maximum of 2 months. At the end of this period, it should definitely be removed.
Risks of the Ureteroscopy (URS) Procedure
Since the ureteroscopy (URS) procedure involves no incision, it does not cause bleeding. However, it still carries certain risks.
The patient's urinary tract may be too narrow which makes it difficult for the ureteroscope instrument to progress. A stent can be placed with the intent to widen the urinary tract. In such a case, the URS procedure is performed after waiting for 2 weeks.
During the URS procedure, the patient's urinary tract is likely to be injured. The injury can be simple or serious. If the wounds are small, they can heal spontaneously. However, injuries involving large ruptures may require open surgery.
There is a risk of postoperative infection in the urinary tract. This condition can be controlled by performing appropriate antibiotic therapy.
After the URS procedure, the patient may observe blood in the urine. In addition, the patient may feel pain on the side where the operated kidney is located. These are temporary conditions.
During the rigid ureteroscopy procedure, a stone in the upper ureter can escape into the kidney. If this possibility comes true, the stone that has escaped into the kidney can be broken with the Flexible URS procedure.
The accuracy of the diagnosis is of great importance.
Calcified plaques in the vessels around the urinary tract are sometimes confused with urinary tract stones. Sometimes, surgery may be recommended unnecessarily for stones that can be discharged spontaneously. Therefore, being evaluated by a well-qualified and experienced physician will protect you from unnecessary surgical operations. Remember the fact that any procedure performed on the body may cause complications, despite being rare!
The use of poor quality materials in the surgery may cause the inability to complete operations, stones remaining in the body, and the development of serious complications in consequence of the surgery. Therefore, the use of high-quality materials in surgeries increases surgical success and reduces the risk of complications.
Importance of a Ureteroscope Device
The size of the ureteroscopes used in the hospital, where the kidney stone surgery will be performed, is important for the success of the surgery. The most commonly used ureteroscope has a thickness of 8 Fr (2.6 mm). In some cases, it is difficult to access the urinary tract by using this device.
Availability of a thinner ureteroscope in the hospital, where the surgery will be performed, increases the chance of performing a successful operation. The smallest ureteroscope currently available has a thickness of 4.5 Fr (1.5 mm). It would be advantageous for the patient to have the operation in a hospital where a ureteroscope of all thicknesses is available.
In some cases, stones in the urinary tract may escape into the kidney during a procedure performed using a rigid ureteroscope. In such a case, if the surgeon has a Flexible Ureteroscope (bendable, flexible ureteroscope) that can break the stones in the kidney as well, he/she can successfully complete the surgery with no need to postpone the operation to a second session. If a Flexible Ureteroscope is not available, a DJ catheter is inserted into the urinary canal, and the operation is then postponed to a second session.
Success Factors in Stone Breaking with URS
In stone-breaking operations performed using the Rigid URS technique, ‘laser’ or ‘mechanical’ breakers are used. Ureteroscopes equipped with laser breakers are not used in many hospitals due to their high cost. However, the success rate of URS operations performed with a laser ureteroscope is considerably high.
The experience of the surgeon is the most important factor in the success of a surgery. A skilled and experienced urologist knows which size tool should be used to enter the urinary tract. He/she knows how to use the tools in order not to cause the stone to go back to the kidney. He/she works carefully so that the patient's urinary canal is not damaged during the breaking process.
Ureteroscopy surgeries performed in inexperienced hands are likely to result in kidney loss!
Prof. Dr. Murat Binbay has performed more than 1.000 Rigid Ureteroscopy surgeries and the success rate of these surgeries is around 99%. While explaining the tricks of ureteroscopy surgeries at international meetings, he refers to the operations he has performed personally.
