Semi-rigid ureteroscopy is a well-known procedure with high success rates for varying urological conditions. It’s recommended for the following cases:
- When a stone in the distal third of the ureter doesn’t spontaneously get expelled because it’s larger than 6 mm
- Severe pain (the stone is not advancing)
- Infection or obstruction of a single kidney
How is a semi-rigid ureteroscopy performed?
A semi-rigid ureteroscopy is an endoscopic surgery.
The procedure involves introducing a device with a lens called a semi-rigid ureteroscope into the ureter and sometimes to the pelvis of the kidney.
This 5 mm diameter optical instrument is connected to a light source, sterile water irrigation tubing and a camera. It also contains a working channel through which various instruments are introduced, such as guide wires, laser fibres and basket probes.
The day surgery is performed under spinal anesthesia, without hospitalization.
It's rarely necessary to dilate the ureter to penetrate more easily with the device. When the obstruction is removed or fragmented, it’s essential to leave a double-J probe in the ureter to avoid postoperative pain. This facilitates the elimination of any debris.
The higher the stone, the more complex the procedure. The procedure sometimes requires a flexible ureteroscope or a second intervention, administered after preparing the ureter by placing a double-J probe to cause progressive dilatation.
The procedure involves introducing a device with a lens called a semi-rigid ureteroscope into the ureter and sometimes to the pelvis of the kidney.
This 5 mm diameter optical instrument is connected to a light source, sterile water irrigation tubing and a camera. It also contains a working channel through which various instruments are introduced, such as guide wires, laser fibres and basket probes.
The day surgery is performed under spinal anesthesia, without hospitalization.
It's rarely necessary to dilate the ureter to penetrate more easily with the device. When the obstruction is removed or fragmented, it’s essential to leave a double-J probe in the ureter to avoid postoperative pain. This facilitates the elimination of any debris.
The higher the stone, the more complex the procedure. The procedure sometimes requires a flexible ureteroscope or a second intervention, administered after preparing the ureter by placing a double-J probe to cause progressive dilatation.
What are the risks and possible complications of a semi-rigid ureteroscopy?
Risks and possible complications are rare (1 to 2 per cent of cases). In cases where bleeding, narrowing of the ureter secondary to the procedure and perforations of the ureter can occur, these complications are usually simple to treat with a double-J probe for a prolonged duration.
The most common difficulty (10 per cent) is the failure of progression in the ureter, caused by a ureteral size that’s too narrow. This is why the need for several operating times is always considered in cases where the ureter is not prepared beforehand by a double catheter J or if the stone to be treated is too big. To avoid the risk of trauma, a double-J is temporarily installed so that the ureter expands on it. It’s then necessary to postpone the intervention and to re-intervene a few weeks later.
The discomforts secondary to double-J are common. Infection or sepsis is possible despite sterile urine and preoperative antibiotic prophylaxis. They can occur quickly on the same day or later.
The most common difficulty (10 per cent) is the failure of progression in the ureter, caused by a ureteral size that’s too narrow. This is why the need for several operating times is always considered in cases where the ureter is not prepared beforehand by a double catheter J or if the stone to be treated is too big. To avoid the risk of trauma, a double-J is temporarily installed so that the ureter expands on it. It’s then necessary to postpone the intervention and to re-intervene a few weeks later.
The discomforts secondary to double-J are common. Infection or sepsis is possible despite sterile urine and preoperative antibiotic prophylaxis. They can occur quickly on the same day or later.
Where is the surgery done?
Surgeries are performed in Quebec's only accredited private hospital, the Centre Métropolitain de Chirurgie.
References
UROLITHIASIS, 2017.
Semi-rigid ureteroscopy: indications, tips, and tricks.
https://www.researchgate.net/publication/321151910_Semi-rigid_ureteroscopy_indications_tips_and_tricks
Semi-rigid ureteroscopy: indications, tips, and tricks.
https://www.researchgate.net/publication/321151910_Semi-rigid_ureteroscopy_indications_tips_and_tricks