Please follow this
for more information about kidney stone disease.
Ureteroscopy entails the passage
of a small telescope, called a
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
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
Once the stone is broken into tiny pieces, these pieces are removed
from the patient. In most cases, a
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
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.
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
For directions to Johns Hopkins Hospital and Johns
Hopkins Bayview Medical Center please click
PRIOR TO THE SURGERY
What to expect during you preoperative
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
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
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
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.
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
• 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.
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.
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.
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.