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Procedures

Laser Semi-Rigid Ureteroscopy

This procedure is suggested in the following cases:

  • When a stone in the distal third of the ureter does not spontaneously get expelled because it is larger than 6 mm
  • In cases of severe pain (the stone is not advancing)
  • In case of infection or obstruction of a single kidney

We begin by introducing a “Sensor”-type metallic telescope to get our bearings and for security purposes. The instrument used is a rigid ureteroscope that is introduced via natural passageways till it reaches the stone. Generally, the stone is fragmented by fibre laser or caught using a “retrieval basket” probe (Zero Tip® in nitinol).

The higher the stone, the more difficult its progress. The procedure sometimes requires a flexible ureteroscope or a second intervention, administered after having prepared the ureter by installing a double J stent to help progressive dilation.

What is a semi rigide ureteroscopy to treat kidney stones?
It is an endoscopic intervention through the uretra the bladder and the ureter (natural ways).

This procedure involves introducing into the ureter, and sometimes to the pelvis of the kidney, a semi-rigide device with a lens that is called a semi-rigide ureteroscope. This 5 mm diameter optical instrument is connected to a light source, a sterile water irrigation tubing and a camera. It also contains a working channel through which various instruments are introduced, such as guides wires, laser fibers and basket probes.
Why do a semi-rigide ureteroscopy for a kidney stone ?
The manipulation of the instruments is done under direct vision and by fluoroscopic guidance (by X-rays).This intervention is proposed in the following cases:
- When a calculation in the distal third of the ureter does not expel spontaneously since its size is greater than 6 mm - In case of severe pain (if the calculation does not progress) - In case of infection or obstruction of a single kidney
How is a semi-rigide ureteroscopy performed?
The procedure is performed under general or spinal anesthesia. It is performed in day surgery without hospitalization. The gesture is made under direct vision using a camera and under a fluoroscopic control. Now, it is rarely necessary to dilate the ureter to penetrate more easily with the device. When the calculation is removed or fragmented, it is necessary to leave in place in the ureter a double J probe which avoids postoperative pain. This facilitates the elimination of any computational debris.

The higher is the stone, the more difficult is 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 very rare (1 to 2% 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%) is the failure of progression in the ureter, caused by too narrow ureteral size. 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 is then necessary to postpone the intervention and to re-intervene a few weeks later.

The discomforts secondary to double J are common. An infection or sepsis is possible despite sterile urine and preoperative antibiotic prophylaxis. They can occur quickly the same day or late.
Where is the surgery done?
Surgeries are performed in the only accredited private hospital in Quebec, at the Metropolitan Surgery Center.

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