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Ureteroscopic lithotripsy (URSL) – Kidney Stones Treatment

Ureteroscopic lithotripsy (URSL) is a minimally invasive procedure used to treat kidney stones. It involves the use of a flexible, fiberoptic scope called a ureteroscope, which is passed into the ureter through the bladder to visualize the stone and fragment it into smaller pieces that can be more easily passed out of the body. URSL is typically used for stones located in the lower part of the ureter or in the bladder, and is particularly useful for stones that are too large to pass on their own or that are causing pain or obstructing the flow of urine. The procedure is performed under general anesthesia or conscious sedation and typically takes 30 minutes to an hour. During the procedure, the urologist will pass the ureteroscope into the bladder, up the ureter, and to the location of the stone. The stone is then fragmented using laser energy or mechanical means, such as a pneumatic lithotripter. Lithotripsy is a medical procedure that uses shock waves or a laser to break down stones in the kidney, gallbladder, or ureter. The remaining particles of small stone will exit the body when a person urinates. Diet Day Before Surgery You may eat a regular diet until midnight the night before surgery. After midnight please do not eat or drink anything. If instructed to do so, you may take your prescription medications with a sip of water. Surgery Procedure Once asleep a small instrument (ureteroscope) is passed through the urethra (water channel) and bladder into the ureter (tube transporting urine from the kidney to the bladder). The Ureteroscopic lithotripsy contains a light and camera that projects an image onto a monitor next to the operating room table. The scope is advanced until the stone is located. If the stone is small it may be grabbed with a basket device and removed intact. However, in most instances, the stone will be too big to be safely removed whole. If so, a laser will be used to break the stone up into several small pieces (lithotripsy) that are grabbed and removed. Alternatively, the laser may be used to turn the stone into numerous small fragments that drain out of the kidney on their own following surgery. In most cases, a urethral stent (a piece of surgical plastic that goes from the kidney to the bladder through the ureter) will be placed at the end of the procedure. The stent keeps the ureter open following surgery. If a stent is not placed the ureter may temporarily swell shut or become occluded by blood clots or stone debris resulting in kidney pain following surgery. In a small number of cases (less than 5%), the ureter is too narrow to safely permit passage of the ureteroscopy into it. When this occurs a urethral stent is placed and stone removal is delayed one to two weeks. The stent gently stretches the ureter allowing safe passage of the scope at a later date.