URS
Ureterorenoscopy (URS) is a minimally invasive procedure for diagnosing and treating conditions in the ureter and renal pelvis-calyx system. In stone therapy, this method is primarily used for the treatment of ureteral stones and kidney stones up to 2 cm in length.
Modern ureterorenoscopes are long and very thin endoscopic instruments equipped with an optical system and one or more working channels. Both rigid and flexible instruments are used.
For planned operations, surgical clearance is obtained from a general practitioner or internist about 2 weeks before admission. The procedure is always performed under general anesthesia.
During the procedure, the ureterorenoscope is inserted through the urethra into the bladder. The ureteral opening is visualized first, and after a thin guidewire is placed, the instrument is advanced into the ureter. If necessary, a contrast agent is used (with the help of an X-ray image converter) to visualize the entire upper urinary tract. The instrument is advanced to the stone. Depending on its location and size, the stone can be fragmented using ballistic shock waves or laser energy or removed with a “stone basket.” I use the latest thulium fiber laser for stone fragmentation. This allows precise adjustment of energy according to the stone’s hardness and size, helping to minimize the movement of stones due to recoil.
At the end of the procedure, the integrity of the ureter is checked, and a ureteral stent (DJ stent) is placed. The ureteral stent is a thin tube that ensures smooth urine drainage after the procedure, reducing the risk of infection complications and severe pain. After surgery, all patients are first taken to the recovery room, where vital parameters are closely monitored until transfer to a regular ward is possible.
The stent is usually removed in 1-2 weeks in the office during a cystoscopy.
As with any procedure, complications can occur with URS. Since access is through a natural body opening and no skin incision is necessary, complications are generally very rare. The most common complications are urinary tract infections with fever, stones moving from the ureter to the kidney, and injuries to the ureter.
I perform these operations at the Landesklinikum Wiener Neustadt. If you are interested, please schedule an appointment in my practice and bring all findings and X-ray images (CDs) with you.
