Ureteroscopy is an endoscopic procedure that is crucial for medical diagnosis. It helps diagnose and treat complicated urologic diseases, including ureteric and renal calculi, strictures, and urothelial carcinomas. Urologists can navigate the complex ureter, bladder, and renal pelvis with precision with ureteroscopes. Moreover, it provides direct viewing, laser lithotripsy, and tissue biopsies.
In particular, digital optics, multiple working channels, and ureteral access sheaths have improved diagnostic accuracy and treatment efficiency. It also avoids open ureteroscopy surgery when Extracorporeal Shock Wave Lithotripsy (ESWL) or Percutaneous Nephrolithotomy (PCNL) are contraindicated, such as during pregnancy or in bleeding disorders. Thus, ureteroscopy is essential in up-to-date endourology for minimally invasive, low-risk treatment.
As a common procedure in urological practice, ureteroscopy is available for various clinical scenarios.
Ureteroscopy can diagnose and remove ureteric stones. It can also treat large ureteral calculi or urinary obstructions. The ureteroscope displays the stone. Stone baskets or laser lithotripsy can be used for removal. Large stones can be broken using ureteroscopy with holmium lasers.
Ureteroscopy can be used for the treatment of upper urinary tract urothelial carcinomas. The ureteroscope facilitates a direct biopsy of suspicious lesions within the ureter or renal pelvis, which provides an accurate diagnosis. Also, it enables precise tumor ablation using laser technology. The ureteroscope is a minimally invasive technique for the observation and removal of recurring or localized urothelial cancer.
Ureteroscopy is also used to address ureteral strictures. A ureteroscope helps surgeons examine the constriction and its severity. No open surgery is needed to treat the stricture using balloon dilation or laser incisions. Stent implantation post-procedure may prevent restenosis and keep ureteral patency.
Ureteroscopy removes foreign bodies from the urinary tract, like migrated stents or broken device fragments. The ureteroscope shows the foreign object for safe forceps or basket retrieval. It avoids more invasive procedures for a direct route to recover misplaced or fragmented instruments.
For patients with unexplained hematuria or radiographic signs of malignancy, the ureteroscope allows targeted biopsy of ureteral lining lesions. It aids in the diagnosis of malignancies or inflammatory chronic ureteritis. The flexibility of the ureteroscope enables access to the upper ureter and renal calyces.
Ureteroscopy can be an effective method to treat UPJ obstruction, allowing for a real-time evaluation of the anatomy at the junction. The ureteroscope may also accomplish endopyelotomy. Here, the narrowed segment is incised using a laser. It can relieve the obstruction without more invasive pyeloplasty.
After ESWL, small stone fragments may remain in the urinary tract. The ureteroscope may remove leftover stone debris or treat steinstrasse when fragmented stones block the ureter. While removing residual fragments, ureteroscopy avoids recurring stones and blockage without surgery.
In patients with congenital oddities, including a duplicated ureter system, the ureteroscope navigates the anatomy. It helps surgeons treat obstruction at the junctions of duplicated ureters. The ureteroscope guidewire handles the proper ureter and treats stone disease and strictures.
Compared to ESWL and PCNL, ureteroscopy has more benefits.
First of all, ureteroscopy provides comprehensive visualization of the ureter and renal pelvis. It offers diagnostic accuracy for stones in the kidney's bottom pole, which other modalities cannot reach. Notably, the ureteroscope is more versatile than ESWL since it can treat radiolucent stones like uric acid or cystine on X-rays.
Further, patients with uncorrected coagulopathies, pregnancy, or anatomic abnormalities from earlier urinary tract reconstruction may only undergo ureteroscopy. Ureteroscopy can diagnose and cure without incisions using laser lithotripsy and baskets to remove stones.
üPatients with large stones.
üActive urinary tract infection (UTI).
üUnresolved or uncorrected bleeding disorders.
üOngoing anticoagulation or antiplatelet therapy.
üSevere ureteral kinking or narrowing.
üImpassable ureteral anatomy due to cancer or reconstruction.
üUreteral strictures that cannot be bypassed with a guidewire.
üInadequate urinary drainage or blockage needing urgent intervention.
üNoteworthy inflammation or infection of the urinary tract.
Ureteroscopes can be categorized into several types depending on various criteria, each possessing distinct features and uses.
Rigid, semi-rigid, and flexible ureteroscopes differ in application per their structural design and clinical use.
Rigid ureteroscopes offer durability and are used for lower ureteric stones due to their inability to navigate sharp angles. Semi-rigid ureteroscopes provide moderate flexibility and suit mid-ureter interventions. Flexible ureteroscopes with up to 270° angulation can reach the upper ureter, renal pelvis, and calyces for difficult intrarenal operations and upper tract stones.
Their lifespan, including single-use and reusable, can also classify ureteroscopes.
Disposable ureteroscopes benefit cases with cross-contamination. They lower damage from sterilization processes. Nonetheless, though costlier upfront, reusable ureteroscopes might be preferred in high-volume settings thanks to their long-term economic perks. Miniaturization and digital progress provide high-resolution images for both types. Yet, reusable models are more durable.
Ureteroscopy passes a narrow ureteroscope through the urethra, bladder, and ureter under general anesthesia. High-definition ureteroscope imaging detects and treats stones, strictures, and malignancies in real time. The Holmium laser may fracture stones while controlling energy to limit retropulsion and tissue injury.
To prevent ureter trauma during instrument insertion, a ureteral access sheath may be used. Even with accuracy, difficulties may arise. Postoperative ureteral stricture, perforation, and injury are hazards. While lowering ureteral edema and guaranteeing drainage, a double-J stent post-procedure may help. Nevertheless, though minimal owing to frequent antibiotic prophylaxis, infection risk exists and needs vigilant monitoring.
At Well Lead Medical, our ureteroscopes provide high-resolution imaging for precision during urological procedures. Wireless transmission capabilities guarantee real-time image sharing. Meanwhile, our devices have multiple sizes, including CPR2/95, CPR2/125, and CPR3/125, for patient requirements. The semilunar design maximizes working channels for irrigation flow and allows ureteral stents.
What is more, we offer nephroscopes and cystoscopes with ergonomic handpieces and compatibility with all brands of light cables and endoscope cameras for greater procedure usability.
