In this, the first of four posts on common treatments for kidney stones, urologist Dr. Evan Goldfischer explores cystoscopy and ureteroscopy.

Ureteroscopy is a minimally invasive procedure done under general anesthesia. Photo: Shutterstock

Why do people get kidney stones? There are lots of reasons. Fortunately, there are a number of treatments available for kidney stones, and in the next several blog posts I’m going to explore them in some detail. The first of these treatments, cystoscopy and ureteroscopy, is considered a surgery, but a minimally invasive one.

Cystoscopy involves inserting an instrument with a light on the end through the urethra into the bladder. In men, the scope is inserted through the opening of the penis, and in women it is inserted into the opening of the urethra. The cystoscope allows doctors to find problems of the urinary tract, including urinary tract infections that didn’t respond to treatment, overactive bladder, painful urination, stones in the bladder, or urinary blockages.

The ureteroscopy procedure

Ureteroscopy takes the procedure one step further. Instead of stopping at the bladder, surgeons thread the small, flexible telescope (called a ureteroscope) from the bladder into the ureter, the tube that carries urine from the kidneys to the bladder. When the kidney stone is found, a wire basket is then passed into the ureter to catch the stone. The stone can also be broken up by a holmium laser if it is very large, and the smaller pieces can then be removed.

When the stone has been removed, a ureteral stent is often inserted to allow any inflammation in the ureter to settle down. The stent can vary in size depending on anatomy, and it can remain in place for anywhere from several days to several months.

The ureteroscopy is done in an operating room, under general anesthesia. Because of this, you’ll spend some time in the recovery room to ensure that your vital signs are stable and that you have no signs of complications. Other post-surgery treatments include IV fluids and pain medication.

After the surgery, you may experience a burning sensation when urinating, but that can be resolved by drinking plenty of fluids (no alcohol, though). Constipation is another common side effect of this surgery, which may be due in part to the opioid medications used to manage post-surgical pain. This issue can be resolved with an over-the-counter stool softener.

A word about stents

There are some drawbacks caused by placement of a stent. Some patients can hardly feel it at all, but others may experience a dull pain in their flank. For some unlucky patients, the stent causes excruciating pain that they say is almost as bad as the pain from the stone itself.

Pain can be caused as the stent rubs against the bladder, which causes a frequent urge to urinate. Discomfort can also be felt because the stent allows urine to flow backward from the bladder to the kidney during urination, which can result in a feeling ranging from mild tingling to intense pain. Stents can cause a urinary tract or kidney infections and significant bleeding, especially for patients who take blood thinners like warfarin.

Also, please note that the stent is not designed to be permanent! Be sure to have it removed at the time your urologist recommends. Leaving in a stent longer than recommended can cause major complications, including kidney failure.

Risks of ureteroscopy

Every surgery has risks, up to and including death. Other than stent pain, potential complications to ureteroscopy include ureteral stricture (an abnormal narrowing of the ureter) and scarring of the ureter. Today, these are rare occurrences thanks to smaller ureteroscopes and the extra precautions by surgeons. Finally, and most severely, it is possible to make a hole in the ureter, which could require prolonged stenting or, at worst, a more advanced reconstructive procedure.

When to call the doctor

If you experience any of the following symptoms after your ureteroscopy, call your surgeon immediately: intense back, stomach, or flank pain; difficulty urinating; fever or chills; or bright red blood or blood clots in your urine. It is normal to have some pinkish-colored urine for about 24 hours after a stent placement, so don’t panic about that.

If you’d prefer to avoid surgical procedures to remove kidney stones—or if you want to dramatically reduce your risk of getting stones—pick up a copy of my book, Even Urologists Get Kidney Stones. It’s a guide to everything kidney stones, including tips on how to avoid getting them.