Urinary stones are known since the ancient times and represent an issue during the life of a percentage of the population. The majority of the patients experience urinary stones as pain called renal colic. This particular pain is associated with the presence of stones in the kidney or ureter. The stones of the kidney and ureteres are a unique urologic problem because of significant complications other than pain that could potentially threaten patient’s life. In particular, the presence of large stones in the kidney or ureters can lead to chronic renal failure and the development of severe urinary tract infection and urosepsis.
Important parameters in the management of ureteral stones are the size, number of stones and their composition. Stones measuring up to 1cm in diameter are frequently expelled automatically. Medication can also accelerate the elimination of ureteral stones and can be administered to patients without contraindications. Depending on the composition of the stone, oral treatment can be administered aiming to the solution of the stone. Extracorporeal shock wave lithotripsy could also be considered for the management of ureteral stones.
Stones in the ureter in addition to conservative monitoring and medication can be treated in different ways according to specific indications:
⇒ Extracorporeal shock wave lithotripsy: The majority of patients have an indication for extracorporeal lithotripsy. But the success of the method depends on many factors including the size, location, composition and hardness of the stone. In addition, patient’s body type plays an important role (i.e obesity). During extracorporeal lithotripsy, the patient lies on a device called Lithotripter. Fluoroscopy is used to identify and target the stone. Ultrasonic waves are emitted from the device and fragment the stone. Therefore, the above procedure is minimally invasive.
⇒ Endoscopic lithotripsy: This method is performed by the introduction of a tool called ureteroscope through the urethra and bladder into the ureter. The stones are identified and fragmented using a laser lithotripsy device.
The fragments are removed by using a special endoscopic basket.
It is worth noting that there are two types of ureteroscopes depending on the flexibility of the instrument. These types include the rigid and flexible ureteroscopes. The flexible ureteroscope can also be used to treat kidney stones. The use of ureteroscope by an experienced urologist gives a solution to many problems with minimal burden to the health of the patient. Stones that have failed conservative or extracorporeal lithotripsy treatment are prime indications for endoscopic lithotripsy. Practically, any ureteral stone (and kidney stone) may be treated with this method.
• Postoperative course
The patient is dismissed from the hospital the next days after surgery. In 2-3 weeks returns for the removal of an internal tube (double-J ureteral catheter). The removal procedure is done under local anesthesia, lasts 3 minutes and is not painful.
The main postoperative complications are hematuria and urinary tract infection leading to prolonged hospitalization.