Minimally Invasive Surgery
Indications
The procedure for viewing the inside of a ureter (a tube that links the kidney with the bladder) is called a ureterorenoscopy. The need to look inside the ureter may arise when there is a stone, a stricture (narrowing) or a tumor affecting passage of urine. Kidney stones typically are formed within the kidney and then pass down into the ureter where they sometimes become lodged and cause extreme discomfort. When associated with infection the condition can become life-threatening. Ureteroscopy allows the surgeon to access the stone, disintegrate it with a laser or remove it with a basket.
Strictures are narrowings of the ureter associated with abnormal, unhealthy tissue. Strictures may form in the ureter after the passage of stones, surgery, radiation therapy for cancer, or for reasons not yet completely understood. However, when a stricture does form and is associated with obstruction of the kidney, it must be corrected. Ureteroscopy allows the surgeon to locate the stricture and repair the ureter in a minimally invasive procedure using balloon expansion, electrical incisions, or lasers.
Cancer that forms in the lining of the urinary system is known as transitional cell carcinoma and may arise anywhere along this tract. When transitional cell carcinoma occurs within the kidney or ureter it is a particularly difficult problem and may be difficult to diagnose since it may be mistaken for a stone, a blood clot or a non-cancerous lesion. When the diagnosis is made, the treatment often involves removing the kidney and ureter on the side where the tumor is present (nephroureterectomy). With ureteroscopy, the urologist is able to more accurately diagnose this disease and in certain situations treat cancer through the ureteroscope.x
Procedure
Ureteroscopy and ureteroscopic surgery can be performed using regional anesthesia or general anesthesia. All procedures are performed using video magnification. Diagnostic procedures typically last 30 minutes to an hour. Therapeutic procedures may last up to two hours. The vast majority of patients are sent home the same day or within 24 hours of the procedure. In some patients, an internal catheter which spans the ureter is placed temporarily. It is removed within 3 to 10 days.
Results
To diagnose transitional cell carcinoma, ureteroscopy is the best test available. It allows the urologist actually to sample a piece of the tumor and send it for evaluation under the microscope.
Our experience in this field suggests that patients with a suspected transitional carcinoma of the ureter and/or kidney should undergo ureteroscopy.
Patients with stone disease (kidney stones) also are excellent candidates for the procedure. Up to 95 percent of patients who undergo ureteroscopy for stones are made stone free. Very few complications have been noted in this group of patients and the majority of patients return home on the day of the surgery or within 24 hours after the procedure.
In treating strictures of the ureter, the success of ureteroscopy is dependent on the length of the stricture and the cause of the stricture. In favorable circumstances the success rate is 80 percent; in less than favorable circumstances, the success rate approaches 50 percent. In either case, the procedure is minimally invasive and presents few problems in experienced hands.