Ureteric stone- URSL
Ureteroscopic lithotripsy (URSL) is a minimally invasive procedure used to treat ureteric stones, which are stones located in the ureters (the tubes connecting the kidneys to the bladder). It is particularly effective for stones that are not passing naturally or causing significant symptoms.
What is URSL?
URSL involves the use of a ureteroscope (a thin, flexible or rigid tube) to access the ureter through the urinary tract. The stone is then fragmented using laser or other energy sources, and the pieces are either removed or allowed to pass naturally.
Indications
URSL is recommended for:
- Stones causing severe pain or obstruction.
- Stones that have not passed naturally despite conservative management.
- Stones causing complications such as infection or hydronephrosis (swelling of the kidney).
- Stones measuring 5–20 mm in size.
Procedure
- Anesthesia: URSL is typically performed under general or spinal anesthesia.
- Access: A ureteroscope is inserted through the urethra, bladder, and into the ureter to locate the stone.
- Fragmentation:
- Laser Lithotripsy (most common): A Holmium laser breaks the stone into tiny fragments.
- Pneumatic Lithotripsy: Uses mechanical energy to break the stone.
- Stone Removal:
- Larger fragments are removed using forceps or baskets.
- Smaller fragments are left to pass naturally.
- Stent Placement (if needed): A temporary DJ stent may be inserted to ensure proper drainage and prevent obstruction due to swelling.
Advantages
- Minimally invasive with no external incision.
- High success rate for stones in the ureter.
- Short hospital stay (usually same-day or 1-day discharge).
- Suitable for stones at any location in the ureter (upper, middle, or lower).
Disadvantages
- Risk of minor complications, such as:
- Ureteral injury or perforation.
- Infection.
- Postoperative pain or hematuria (blood in urine).
- May require a second session for large or complex stones.
Recovery
- Most patients recover within a few days.
- Temporary discomfort or burning sensation during urination may occur.
- DJ stent removal (if placed) is typically scheduled 1–2 weeks after the procedure.
Post-Procedure Care
- Drink plenty of fluids to help pass residual fragments.
- Take prescribed pain relievers and antibiotics as directed.
- Avoid strenuous activities for a few days.
- Watch for symptoms like fever, severe pain, or difficulty urinating, and report them to the doctor immediately.
Follow-Up
- Regular imaging (ultrasound or CT scan) to ensure complete stone clearance.
- Evaluation for underlying causes of stone formation, such as dietary habits or metabolic disorders, to prevent recurrence.
When to Choose URSL
URSL is particularly effective for ureteric stones that:
- Are too large to pass naturally.
- Cause severe symptoms or complications.
- Are located in the lower ureter, where it is highly successful.
If you’re considering treatment for ureteric stones, consult a urologist for personalized advice and care.
