April 19, 2014


URETEROSCOPY


GENERAL INFORMATION
  
    Overview
    About your surgeons
    Appointments

    Print this page

PRIOR TO THE SURGERY

    Preoperative consultation
    Preoperative tests
    Preparation for surgery



THE SURGERY

    The Procedure
    Video Clips
   


AFTER SURGERY

    After hospital discharge

 


OVERVIEW

Please follow this link http://urology.jhu.edu/kidney/stones.php for more information about kidney stone disease.


Ureteroscopy entails the passage of a small telescope, called a the ureteroscope, through the urethra and bladder and up the ureter to the point where the stone is located. If the stone is small, it may be snared with a basket device and removed whole from the ureter. If the stone is large, or if the diameter of the ureter is narrow, the stone will need to be fragmented, which is usually accomplished with a laser. Once the stone is broken into tiny pieces, these pieces are removed from the patient. In most cases, a ureteral stent is left in place temporarily following ureteroscopy, to ensure that the kidney drains urine well.

Ureteroscopy usually can be performed as an outpatient procedure however; patients may require an overnight hospital stay if the procedure proves lengthy or difficult.

Advantages of Ureteroscopy

Ureteroscopy can treat stones located at any position in the ureter and kidney. Additionally, ureteroscopy allows the treatment of stones that cannot be seen on an x-ray. Certain patients who cannot be treated with ESWL or PERC, such as those who cannot safely stop taking blood thinners, women who are pregnant, and the morbidly obese, can be treated by ureteroscopy.

Ureteroscopy is NOT a particularly good treatment for:

Patients with large stones – because ureteroscopy requires actively removing all stone fragments, the treatment of very large stones may yield so many fragments that complete removal becomes impractical or impossible.

Patients with a history of urinary tract reconstruction – the anatomy of patients who have undergone ureteral or bladder reconstruction may not allow the passage of a ureteroscope.

OUR SURGEONS

       
  Office: 410-502-7710
  Appointments:410-955-6100
  Fax:410-502-7711
  Email: mallaf@jhmi.edu
      
      
  Office: 410 502-7710
  Appointments:410 955-6100
  Fax:410 502-7711
  Email: bmatlag1@jhmi.edu


 APPOINTMENTS

Johns Hopkins Hospital Patients and Johns Hopkins Bayview Medical Center Patients please use the phone numbers listed above.

In the event of an emergency and you need to contact someone in the evening hours or on the week end, please call the paging operator at 410-955-6070 (for Johns Hopkins Hospital Patients) or 410-550-0100 (for Johns Hopkins Bayview Medical Center Patients) and ask to speak to the urologist on call.

For directions to Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center please click here

 

  PRIOR TO THE SURGERY

What to expect during you preoperative consultation

During your initial consultation with your surgeon, he will review your medical history as well as any outside reports, records, and outside Xray films (e.g. CT scan, MRI, sonogram). A brief physical examination will also be performed at the time of your visit. If your surgeon determines that you are a candidate for this procedure, you will then meet with a Patient Service Surgery Coordinator to arrange for the date of your procedure.


NOTE: It is very important that you gather and bring all of your Xray films and reports to your initial consultation with your surgeon.

 



What to expect prior to the surgery


Since insurance companies will not permit patients to be admitted to the hospital the day before surgery to have tests completed, you must make an appointment to have pre-operative testing done at your family doctor or primary care physician's office within 1 month prior to the date of surgery.


For Johns Hopkins Hospital Patients: These results need to be faxed by your doctor's office to the Pre-operative Evaluation Center at 443-287-9358 two weeks prior to your surgery. Please call The Documentation Center at 410-955-9453 two weeks before your surgery date to confirm that this information was received.


For Johns Hopkins Bayview Medical Center Patients : These results need to be faxed by your doctor's office to the Pre-operative Evaluation Center at 410-550-1391 one week prior to your surgery. Please call The Documentation Center at 410-550-2495 before your surgery date to confirm that this information was received.


Once your surgical date is secured, you will receive a form along with a letter of explanation to take to your primary care physician or family doctor in order to have the following pre-operative testing done prior to your surgery.

  • Physical exam

  • EKG (electrocardiogram)

  • CBC (complete blood count)

  • PT / PTT (blood coagulation profile)

  • Comprehensive Metabolic Panel (blood chemistry profile)

  • Urinalysis

Preparation for surgery


Medications to Avoid Prior to Surgery

Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided 1 week prior to the date of surgery (Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval).

It is very important that your last urine culture was negative prior to having this procedure. Please call the physician’s office at least one week before this procedure to confirm your urine culture results. If you suspect that you may have a urinary tract infection, please call the physician office immediately so that proper antibiotics can be prescribed before your surgery.

 

THE SURGERY

The Procedure

Ureteroscopy is a minimally invasive technique that, as the name implies, involves a small telescope, called a ureteroscope that is passed through the urethra, into the bladder, and then up the ureter to the place where the stone is located. The ureteroscope is passed to the stone by a combination of visual and x-ray guidance. Ureteroscopy is typically performed under general anesthesia, and the procedure usually lasts from one to three hours.

Depending on the nature of the stone identified with the ureteroscope, the urologist will:


• If the stone is small, trap it in a basket and remove it intact.
• If the stone is large, fragment it into tiny pieces with a laser.

The passage of the ureteroscope may result in swelling in the ureter. Therefore, it may be necessary to temporarily leave a small tube, called a ureteral stent, inside the ureter.



Figure 1



Video Clips

Warning: these video clips include footage from an actual surgery which some viewers may find difficult to watch.

 




What to expect after discharge from the hospital

  • Pain Control:You can expect to have some pain that may require pain medication for a few days after discharge, and then Tylenol should be sufficient to control your pain.

  • Showering: You may shower at home.

  • Activity: Taking walks is advised. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible. Driving should be avoided for at least I day after the procedure. Absolutely no heavy lifting (greater than 20 pounds) or exercising (jogging, swimming, treadmill, biking) until instructed by your doctor. Most patients return to full activity on an average of one week after surgery. You can expect to return to work in approximately 1 week.

  • Diet: No dietary restrictions. Increase fluid intake until your stent is removed.

  • Follow-up Appointment: You will need to call soon after your discharge to schedule a follow up visit for 1-4 weeks after your procedure date.
    • To schedule an appointment at The Johns Hopkins Out Patient Center call 410-955-6101.
    • To schedule an appointment at Johns Hopkins Bayview call 410-550-7008.

  • Ureteral Stent Removal: The length of time the stent remains in place is variable. Your doctor will probably request it to be removed within a 3 days to a several week period. This can be removed in the doctor's office. It is common to feel a slight amount of flank fullness and urgency to void as a result of the stent. These symptoms often improve over time as the body adjusts to the indwelling stent. It is critical that patients return to have their stent removed as instructed by their physician as a prolonged indwelling ureteral stent can result in encrustation by stone debris, infection, obstruction and loss of kidney function.

 

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