what to expect for lithotripsy and stent for male

Ureteroscopy and Light amplification by stimulated emission of radiation Lithotripsy

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Kidney stones affect 1 in 500 Americans each year, causing pregnant pain and healthcare expense.

Surgical options for patients with symptomatic kidney stones include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy  (PCNL). Your renal anatomy, stone composition, and body habitus all play major roles in determining outcomes and operative approach.

The role of ureteroscopy over the last ten years has undergone a dramatic evolution, due to improvements in the ureteroscope size and deflection capabilities, video-imaging, miniature baskets and instruments, and in lithotripsy (stone breakage) with the advent of holmium laser. Over 25% of all kidney stone surgeries are now done using small ureteroscope technology.

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Our Surgeons

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Vincent One thousand. Bird, Md
Professor
David A. Cofrin Endowed Chair in Endourology
Chief, Division of Minimally Invasive Surgery
Department of Urology
Click here for Video Biography

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Benjamin K. Canales, MD, MPH
Associate Professor
Department of Urology
Click here for Video Biography

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Russell S. Terry, Medico
Assistant Professor
Director of MIS Education and New Technologies
Department of Urology
Click here for Biography

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Prior to Procedure

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What to expect during your initial consultation:

• Information technology is of import that prior to your initial clinic consultation thatall Xray films and their reports (e.g. CT scans, intravenous pyelogram or IVP, sonogram, or MRI) are compiled and brought to your appointment for careful review by your surgeon. These films can be requested along with the radiology report from the facility that performed the Xray. A review of your medical history and a physical examination will be performed along with blood and urine tests if needed. If your surgeon determines that you are a candidate for ureteroscopy, y'all will and so meet with a Surgery Scheduling Coordinator to arrange for the date of your procedure.

What to expect prior to surgery:

• Once your surgery date is secured by i of our Surgery Scheduling Coordinators, the items listed beneath will be ordered as necessary based upon your age, medical history and risk for surgery. These volition be performed through a preoperative anesthesia consultation at the Presurgical Center at UF & Shands that volition exist arranged for you lot at your initial visit. During this consultation you will have the opportunity to speak to the anesthesia staff regarding the types of anesthesia available and the risks/benefits.
  • Physical exam
  • EKG (electrocardiogram)
  • CBC (consummate blood count)
  • PT / PTT (blood coagulation profile)
  • Comprehensive Metabolic Console (claret chemistry contour)
  • Urinalysis

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Grooming for Surgery

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Medications to Avoid Prior to Surgery:

• Ureteroscopy is the simply minimally-invasive, rock surgery that can be performed while on active anti-coagulation. Even with this option, information technology is most preferable to discontinue all claret thinners prior to surgery, if medically possible. Please contact your surgeon's office if you are unsure about which medications to cease prior to surgery.  The following is a list of medications to avoid at least seven-ten days prior to surgery.  Many of these medications can alter platelet role or your body's power to clot and therefore may contribute to unwanted haemorrhage during or after surgery. Practice not stop whatever medication without contacting the prescribing doctor to get their approval.
  • Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin Due east, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix
  • A formal list of these medications and others will be provided to you by our Surgery Scheduling Coordinators.

There is no bowel preparation needed for ureteroscopy, and almost patients are asked to be NPO ("nix by oral cavity") after midnight of the night prior to surgery.

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The Surgery

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Once you lot are asleep, the surgeon passes a small lighted tube (ureteroscope), through the urethra and float and into the ureter to the point where the stone is located. If the rock is small, it may be snared with a basket device and removed whole from the ureter. If the stone is large and/or if the diameter of the ureter is narrow, the rock will need to be fragmented, which is normally accomplished with a light amplification by stimulated emission of radiation. Once the rock is cleaved into tiny pieces, these pieces are ordinarily removed from the ureter. In nearly cases, to ensure that the kidney drains urine well after surgery, a ureteral stent is left in identify (see FAQs).

Ureteroscopy tin can also exist performed for stones located within the kidney. Similar to ureteral stones, kidney stones tin exist fragmented and removed with baskets. Occasionally, a kidney stone volition fragment with a laser into very modest pieces (grains of sand), too small to be basketed. The urologist will normally leave a stent and allow these pieces to clear past themselves over time. Lastly, if the ureter is too pocket-size to advance the ureteroscope, the urologist will usually leave a stent, allowing the ureter to "dilate" around the stent, and reschedule the procedure for 2-3 weeks later. Ureteroscopy is commonly performed as an outpatient process. Some patients, nevertheless, may require an overnight hospital stay if the procedure proves lengthy or difficult.

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Potential Risks and Complications

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As with whatever major surgery, complications, although rare, may occur with ureteroscopy. Potential risks and complications with this operation include but are not express to the following:

• Stent pain: About 50% of patients who undergo ureteroscopy and take a stent volition take "stent hurting," and this is by far the most common risk/complaint post-obit ureteroscopy. A stent is a soft plastic tube (most half the size of IV tubing) that allows the kidney to drain to the bladder regardless of edema or obstacle. Not only tin the stent "rub" on the inside of the bladder, causing a feeling of needing to urinate/overactive bladder, merely as well the stent allows urine to pass up from the bladder to the kidney during urination – causing symptoms from a warm, tingling sensation to intense pain in the afflicted flank. Enquire your surgeon most the risks/benefits of a ureteral stent following surgery.
• Stone fragments:Residuum stones within the kidney or ureter may be present up to 40% of the time following ureteroscopy, depending on the original stone size and location. These stone fragments will be seen and addressed on follow-upwards imaging. Ask your urologist to give yous some idea of success rates for your detail stone size and location.
• Ureteral injury:Injury to the ureter is the virtually common intra-operative complication during ureteroscopy. The reported risk of perforation ranges profoundly, depending on whether it is defined as a complete perforation (0.1-0.seven% — think of this as a hole through the entire ureter), a partial perforation (1.6% — a hole nearly through the unabridged ureter), or mucosal tear/scrape (5% — these are similar to a sore on the inside of the mouth). Nearly 100% of these will heal with prolonged stenting (anywhere between 2 – 4 weeks). Should a large perforation occur, your urologist may chose to stop the procedure and return on another day when the ureter has had fourth dimension to heal. Should your urologist not be able to identify a stent later a perforation, a tube called a "nephrostomy tube" volition be placed through the skin of your dorsum into the kidney. This tube temporarily diverts the urine away from the hole and out into a bag until healing can occur and the hole close.
• Ureteral stricture and avulsion:Ureteral strictures (scar tissue within the ureter) and ureteral avulsion (consummate dissociation of the ureter from the kidney) are the nigh feared complication of ureteroscopy. Fortunately, due to the appearance of small ureteroscopes and heightened surgeon awareness, the risk of avulsion (0.05%, 1/2000) or stricture (0.2%, 1/500) is rare.
• Hematuria and infection:Bleeding and infection are certainly possible following ureteroscopy (five%), but most of these are self-limiting and resolve with hydration and antibiotics, respectively.

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What to Expect Afterward Surgery

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• Immediate p ost-operative catamenia: After the surgery you will exist taken to the recovery room. If a urinary catheter (foley) was placed during surgery, this may be removed by your nurse once you are awake, alert, and moving comfortably. Once your pain is controlled and you are able to urinate, you may be discharged from the recovery room to abode. Expect blood in the urine with almost every urination. With fourth dimension and hydration, the urine should slowly plow from a watermelon ruby-red color to pink to clear. Yous may have stent pain or bladder spasms (see complications of ureteroscopy above) that can be helped by overactive bladder medications or by an indwelling foley catheter. Due to instrumentation, nigh patients will receive 4-5 days of oral antibiotics to prevent a urinary tract infection.
• Postoperative Pain:Most patients later on ureteroscopy experience mild to moderate hurting in the flank and/or bladder area. This is more often than not well controlled by use of oral narcotics (pain medication) such as Percocet or Vicodin. Every bit you get farther out from your ureteroscopy, y'all may exist able to decrease the strength of the medication to Actress Strength Tylenol or Motrin, as narcotics may cause constipation and sedation.
• Ureteral Stent:Almost always subsequently ureteroscopy, a minor tube called a ureteral stent will be placed. The stent serves to facilitate drainage of urine down to the bladder.  At a later on date, the stent will be removed in the office by your surgeon. Y'all may experience bladder spasms related to the ureteral stent that was placed at the terminate of your process (run into FAQs).
• Nausea: Nausea is fairly mutual following whatever surgery especially related to general anesthesia. This is ordinarily transient and is cocky-limiting. Should you have excessive nausea and airsickness, you should contact your surgeon for advice.
• Showering:  Patients can shower immediately upon belch from the hospital
• Activity:  Patients may begin driving once they are off all narcotic pain medication. Nigh patients are able to perform normal, daily activities within 5-7 days after ureteroscopy. Withal, many patients describe more than fatigue and discomfort with a ureteral stent in the bladder. This may limit the amount of activities that yous tin perform.
• Nutrition:Nearly patients only desire clear liquids for the first 24 hours post-obit ureteroscopy, equally your abdominal function may be sluggish due to the furnishings of surgery and full general anesthesia. Following this flow, Patients may resume a regular diet as tolerated.
• Fatigue:Fatigue is quite common post-obit surgery and should subside in several days following surgery.
• Constipation/Gas Cramps:You may feel sluggish bowels for several days following your ureteroscopy as a result of the anesthesia. Suppositories and stool softeners are normally given to aid with this problem. Taking a teaspoon of mineral oil daily at home will also help to forestall constipation. Narcotic pain medication can also cause constipation and therefore patients are encouraged to discontinue any narcotic pain medication every bit soon later surgery as tolerated.
• Follow-upwardly Appointment: Patients should brand a follow-upwards appointment with their surgeon by contacting theUF Wellness Medical Plaza Urology Clinic at 352.265.8240. Your surgeon will allow you lot know the timing and schedule of dispensary visits following surgery.

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Oftentimes Asked Questions (FAQs)

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What are the advantages of ureteroscopy compared to other stone treatments?

• Provided that the kidney stones are an advisable size and location, an advantage of flexible ureteroscopy is that it allows entry into all parts of the kidney. As long as the ureter is large enough to permit the ureteroscope to laissez passer, there is a good chance that the rock can be cleaved and removed with one surgery.
• Compared to SWL, a kidney or ureteral stone can be seen under direct vision by the ureteroscope, allowing lithotripsy with lasers followed by basketting and removal. With shock wave lithotripsy, patients are asked to pass stone fragments themselves, causing potential additional pain or obstacle. Additionally, daze moving ridge lithotripsy may not break up very dense, hard stones (termed SWL resistant stones). Ureteroscopy with a contact holmium laser can break up whatsoever stone, every bit long every bit the stone itself is attainable to the ureteroscope. Additionally, ureteroscopy allows the treatment of stones are invisible on apparently ten-ray ("acid" stones).
• Compared to percutaneous procedures, the ureteroscope is passed through natural body orifices and involve no skin incisions. Information technology is an outpatient procedure, where PCNL requires at to the lowest degree an overnight hospital stay. Sure patient groups who cannot be treated with ESWL or PCNL (such every bit patients on blood thinners, women who are pregnant, the morbidly obese, and airline pilots/astronauts) tin be treated safely and effectively by ureteroscopy.

Who is non a proficient candidate for ureteroscopy?

• Patients with large stones:Considering ureteroscopy requires active removal of all or most rock fragments, the handling of very large stones (>2 cm) may yield so many fragments that complete removal becomes impractical or impossible.
• Patients with a history of urinary tract reconstruction:The beefcake of patients who have undergone ureteral or float reconstruction may not allow for passage of a ureteroscope.
• Patients who are intolerant of stents:Equally stents are usually about routinely post-obit ureteroscopy, patients with a history of stent intolerance may be more than comfortable with other stone approaches.

What are the success rates of ureteroscopy?

• Depending on rock size, location, and number, success rates vary anywhere from 50% – ninety%. Ask your surgeon to hash out success rates tailored to your particular rock disease.

How long will my stent stay in identify?

• The length of time the stent remains in your ureter is variable. Your doctor will probably request it to exist removed somewhere between 5- ten days after your procedure. Well-nigh 50% of patients feel flank fullness (unremarkably during voiding) and urgency as a outcome of the stent. These symptoms oftentimes improve over time.It is disquisitional that you lot render to have your stent removed (as instructed), as a prolonged indwelling ureteral stent can result in encrustation, chronic infections, chronic kidney obstruction, and eventual loss of kidney function.

What is a ureteral stent?

• The ureter is the natural tube that transmits urine from the kidney to the bladder. A ureteral stent is a specially designed hollow tube, fabricated of a soft, plastic material that is placed inside the lumen of the ureter. This tube facilitate urine passage until the obstacle has resolved. Stent size and lengths vary according to patient characteristics.

What's the reason for having a stent placed?

• The placement of a ureteral stent allows urine to menstruum from the kidney to the float, even when the ureter is obstructed (stones, edema, external compression, tumors, clots, etc). Considering of the stent, the kidney can continue to function properly while avoiding the pain that tin can occur when the kidney is obstructed. Additionally, ureteral stents allow the kidney to clear bacterial infections associated with obstruction.
• Following ureteral or kidney surgery, the stent protects the ureter and allows the ureter to heal even when damaged. If a stent is non placed following surgery, occasionally, the ureteral lumen can heal with what is called a stricture. Stents are thought to prevent this from occuring, as they permit for healing in the shape of a tube.
• Occasionally, a stent is placed in order to allow the ureter to dilate over a catamenia of time. This tin be of import when access through the ureter is needed to pass instruments or remove stones. Clinically, this is seen when the bore of the ureter is too pocket-size to allow for passage of instruments or when a ureteral stone has narrowed the lumen of the ureter due to edema or inflammation. Inserting a stent allows the ureter to passively dilate, in the hope of making later attempts to get up the ureter successful.

What are the disadvantages of having a ureteral stent?

• About 50% of patients will take some blazon of side-effect associated with their stent. It is not possible to predict who will have stent-associated difficulties or when the stent symptoms will resolve. Some patients have stent symptoms for just a few days, while others find their symptoms persist throughout their entire stent duration. Ureteral stent symptoms may include:
  • Hematuria:Stents tin cause claret to appear in the urine at various times. Usually, concrete action of one kind or other results in motion of the stent inside the body. This can requite rise to claret in the urine. Pain may be felt in the back (loin), bladder area, groin, penis in men or urethra in women, and sometimes the testicles. The discomfort or pain may exist more noticeable after concrete activities and subsequently passing urine.
  • Bladder spasms:The stent tin can rub and irritate the lining of the bladder, making information technology necessary to laissez passer urine more than ofttimes during the day and at night. These symptoms can occasionally be improved by medication.
  • Incontinence:Rarely, a stent may cause such float spasms leading to urinary leakage. This can commonly be controlled with oral medications or with stent removal.
  • Stent migration:Stents may motion from their intended positions to other parts of the urinary tract, causing pain or incontinence.
  • Infection:As stents are foreign bodies, bacteria can attach to their surface and become protected by a layer of slime known equally a "biofilm." These leaner may then be released into the urine, causing infection and fever. These infections may temporarily exist cleared with antibiotics, but unremarkably recur 2-3 weeks later on antibiotics as the antibiotics are unable to penetrate the biofilm.
  • Encrustation:Stents may exist forgotten by patients and their care-givers. Over time, they tin can get coated with urinary salts and minerals and eventually become i very large calcified rock. This may atomic number 82 to chronic obstruction, pain, chronic infections, or even consummate atrophy (death) of that kidney. Typically, ii-iii procedures are necessary to remove these calcified stents.

How is a stent inserted?

• A stent is inserted usually under a general anesthesia, often in combination with other procedures (depending on the reason for the stent). A telescope chosen a cystoscope is passed through the urethra and into the bladder. The stent is then passed through the cystoscope and into the ureter with the use of a guide wire, and its position is confirmed using 10-rays.

How is a stent removed ?

• Under local anesthesia in the urology clinic, a special flexible telescope (cystoscope) is passed through the urethra into the bladder. The ureteral stent is picked up with a grasper and removed.

How does a stent interfere with daily life?

• Most patients are able to perform normal, daily activities with a stent in place. All the same, many patients describe more fatigue and discomfort during the day, limiting the amount of activities that tin perform. Additionally, every bit some patients have bladder spasms that require using a toilet more frequently, travel may exist more slow or difficult. Ureteral stents do not limit sex activity, although there may be less enjoyment as a issue of the side-effects described above.

What boosted intendance is necessary when a stent is in identify?

• No item cares are necessary. Drink at least 1½ to ii liters of fluids a day is encouraged to assistance to dilute the urine. Discuss with your doctor or nurse if you have troublesome side-effects.

Following stent placement, when might it exist necessary to call a doctor?

• Yous should contact your urologist if the stent is causing you constant, unrelenting pain, if you lot have symptoms of a urinary tract infection (fever, rigours, feeling unwell and pain passing urine), or if the stent falls out.

What alternatives are there to a ureteral stent?

• It may be reasonable not to leave a ureteral stent if obstruction is likely to be transient. Your surgeon decides at the time of the procedure whether or not your circumstance warrants "stent gratuitous." Occasionally, information technology may be possible to identify a tube externally that drains the kidney. This tube is placed directly through the peel, through the kidney, and into the urinary space, called a 'nephrostomy' tube. This is placed under ultrasound or fluoroscopic Xray guidance. As the tube remains outside the body, it is slightly more inconvenient, has college infection rates, and tin can sometimes get pulled out by accident. The reward of a nephrostomy tube is better drainage, ability to place contrast into the kidney to evaluate for obstruction or leakage, and removal that does not require a cystoscopic procedure.

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Source: https://urology.ufl.edu/patient-care/stone-disease/procedures/ureteroscopy-and-laser-lithotripsy/

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