Kidney stones are a common urological issue affecting millions of people worldwide. When these stones become lodged in the urinary tract, they can cause severe pain, infection, or urinary obstruction. One of the most advanced and minimally invasive treatments for such conditions is Ureteroscopic Lithotripsy Surgery.
What is Ureteroscopic Lithotripsy Surgery?
Ureteroscopic lithotripsy (also known as URS or URS lithotripsy) is a minimally invasive surgical procedure used to treat urinary stones, particularly those in the ureters or kidneys. It is performed using a thin, tube-like instrument called a ureteroscope, which is inserted through the urethra and bladder, and advanced up into the ureter or kidney.
Once the stone is located, it is either removed directly or broken into smaller pieces using laser energy (typically a Holmium laser), which can then be flushed out through the urine or extracted with tiny instruments.
Why is Ureteroscopic Lithotripsy Performed?
Ureteroscopic lithotripsy is primarily recommended when:
- Stones Are Too Large to Pass Naturally
Small kidney or ureteral stones often pass on their own with time, hydration, and medication. However, stones larger than 5-6 mm may become stuck and require surgical intervention.
- Severe Pain or Blockage
Stones causing intense pain, hematuria (blood in urine), or urinary obstruction need to be treated promptly to avoid further complications such as infection or kidney damage.
- Recurrent Urinary Tract Infections (UTIs)
When stones repeatedly cause infections or inflammation, surgical removal through lithotripsy becomes necessary.
4. Conservative Treatments
If extracorporeal shock wave lithotripsy (ESWL) or medical therapy doesn’t work, ureteroscopic lithotripsy becomes the next best option.
How Does the Procedure Work?
Pre-Procedure Preparation:
- Medical evaluation: Includes imaging (ultrasound, CT scan, or X-ray) to locate and size the stones.
- Fasting and medication adjustment the night before surgery.
- Anesthesia: The procedure is performed under general or spinal anesthesia.
Step-by-Step Procedure:
- Insertion of Ureteroscope: A thin, flexible or semi-rigid tube is inserted through the urethra and bladder.
- Stone Location: The surgeon navigates the ureteroscope to locate the stone.
Lithotripsy: The stone is either:
Fragmented using a laser (laser lithotripsy), or
Extracted using a stone retrieval basket.
- Stent Placement (Optional): A temporary ureteral stent may be placed to facilitate urine flow and healing.
- Completion: The ureteroscope is withdrawn and the patient is monitored in recovery.
Types of Ureteroscopic Lithotripsy
- Laser Lithotripsy (Holmium YAG laser): Most common and precise, used to break stones into dust-like particles.
- Pneumatic Lithotripsy: Uses mechanical energy but is less commonly used due to potential tissue damage.
- Ultrasonic Lithotripsy: Uses sound waves but mostly in larger or more advanced systems.
Benefits of Ureteroscopic Lithotripsy
- Minimally Invasive: No external incisions required.
- High Success Rate: Effective for stones in the kidney and ureter.
- Quick Recovery Time: Most patients go home the same day or within 24 hours.
- Reduced Hospital Stay: Compared to open or percutaneous surgery.
- Suitable for All Stone Types: Works for all compositions, sizes (up to ~2 cm), and locations in the urinary tract.
Recovery and Aftercare
Immediately After Surgery:
- You may experience mild discomfort, burning during urination, or blood-tinged urine for a few days.
- A ureteral stent (if placed) may cause temporary urgency, flank pain, or frequent urination.
Home Care Tips:
- Drink plenty of fluids to help flush out stone fragments.
- Avoid strenuous activities for a few days.
- Take prescribed antibiotics and painkillers.
Follow-up appointment to check for remaining stones or remove the stent.
When to Seek Medical Attention:
- High fever or chills
- Persistent pain or blood in urine
- Inability to urinate
Risks and Complications (Rare but Possible)
Like any surgical procedure, ureteroscopic lithotripsy has some associated risks:
- Infection or bleeding
- Injury to the ureter
- Stone fragments not fully cleared
- Ureteral stricture (narrowing)
- Discomfort from stent
These risks are minimized when the surgery is performed by a skilled urologist.
Who is a Good Candidate?
Ideal candidates for ureteroscopic lithotripsy include:
- Individuals with stones stuck in the ureter or kidney
- People who have failed conservative treatment
- Patients who are not ideal for ESWL
- Those who need immediate relief from pain or infection
It is generally safe for both adults and children.
Cost of Ureteroscopic Lithotripsy in India
The cost of ureteroscopic lithotripsy can vary depending on the hospital, city, surgeon’s expertise, and whether a stent is used. On average, the procedure costs between ₹45,000 to ₹1,20,000 INR.
For insurance holders, many policies cover this surgery under urology or daycare procedures. Always check with your provider in advance.
- Alternatives to Ureteroscopic Lithotripsy
- Medical Expulsion Therapy (MET)
- ESWL (Shockwave Lithotripsy)
- PCNL (Percutaneous Nephrolithotomy) for larger stones
- Open surgery (rare and only for complex cases)
Conclusion
Ureteroscopic lithotripsy surgery is a safe, effective, and minimally invasive solution for urinary stones that are too large or painful to pass naturally. With high success rates and minimal recovery time, it offers a reliable alternative to more invasive methods. If you’re experiencing recurrent kidney stones or pain due to ureteral obstruction, consult a qualified urologist to determine if ureteroscopic stone removal is right for you.
