Treatment

During a ureteroscopy a thin telescopic like instrument called a ureteroscope is passed into the bladder through the urethra and up into the ureter.

A ureteroscopy is often the best way to see what is going on in the ureter. It is useful in seeing if stones are blocking the ureter and to detect any changes in the ureteric lining, such as inflammation, cancer or scarring.

During a ureteroscopy treatment can also be given. If necessary the doctor can take tissue samples, remove growths or incise or dilate scar tissue that may be causing an obstruction of the ureter. Stones within the ureter can also be treated. These can be grasped with special forceps or baskets or alternatively they can be shattered with ultrasound or shock waves or vaporised with the laser.

Your Consent

We need your permission for your operation to go ahead. Before you sign the consent form it is important that you understand the risks and effects of the operation and anaesthetic. These will be discussed with you by your doctor and the nurse, should you have any questions, your nurse or doctor would be happy to answer these.

It would be a very rare occurrence to require a blood transfusion with this surgery. However, in the unusual event that you did need a blood transfusion and you want to refuse one, it is vital that you tell your surgeon and nurse prior to your operation.

About Your Anaesthetic

You will NOT be allowed to eat or drink anything for at least six hours before your surgery. This includes chewing gum and sweets.

There are two main types of anaesthetic used for this surgery;

• General Anaesthetic: You will be asleep throughout the operation and remember nothing of it.
• Regional Anaesthetic e.g. Spinal, Epidural or Caudal: A needle is placed into your back and a solution is injected that will numb your body from the waist down. You will be awake but you maybe sleepy and you will not feel the operation.

Feel free to discuss these options, and your questions with the anaesthetist.

You must not drive any vehicle or operate any machinery for 24 hours after having an anaesthetic. You will have to arrange for someone to drive you home if you go home within 24 hours of your surgery.

Your Operation

On admission, you will be informed of your approximate time of surgery and prepared for theatre by your nurse.

You may be given some tablets before theatre. These are charted by your anaesthetist and may include tablets for tension, nausea and pain prevention.

You will be escorted to the theatre where you will be transferred to the operating table. Anaesthetic staff will then insert a drip in your arm and attach various monitoring devices.

Once you have been completely prepared and given your anaesthetic, surgery will begin. The time the operation lasts will depend on what the urologist sees, if a stone needs to be removed this can take anywhere from five minutes to two hours. In most cases, the operation lasts about half an hour.

When the operation is completed, you will go to the recovery room for a short while where you will be cared for until you are ready to be transferred to the ward.

After Surgery

Your nurse will check your blood pressure and pulse routinely.

You may have a drip in your arm so you get enough fluid until you are drinking normally. You can usually eat and drink when you return to the ward.

Your nurse will help you get out of bed for the first time, once you have recovered from your anaesthetic. If you had a spinal anaesthetic, you may be asked to lie flat for several hours after returning to the ward to allow for the anaesthetic to wear off.

After surgery your urine may be slightly blood stained and because urine is naturally acidic you may experience slight ‘stinging’ when passing urine for the first few times. If the stinging is more severe it can be relieved by adding ural or citravescent to your drinking water, which neutralises the acid in the urine. Please tell your nurse if you have any pain or discomfort at any time so you can be given the appropriate care and treatment.

Depending on your type of operation, you may return from theatre with a ureteric stent in place. This thin, soft tube sits within the ureter. Both ends of the stent are looped with one loop sitting within the kidney and the other within the bladder. If surgery is difficult to perform because of a blocked, swollen, inflamed, or fragile ureter, it is much safer to put a stent in to allow the ureter to settle down for several weeks and repeat surgery at a later date. However, most stents are placed at the end of surgery when there is swelling, inflammation or stone fragments within the ureter that could potentially cause a blockage. If you do have a stent placed this would be removed anywhere from 4-12 weeks after surgery under local anaesthetic, in the Out Patient Clinic. A flexible telescope is passed up the urethra to the bladder so the end of the stent can be grasped and it can be removed. If the stent was placed due to an inoperable obstruction it would usually be replaced with a new stent every 3-12 months depending on the reason for its placement.

Most ureteroscopies are day stay procedures only and you are able to go home soon after your return to the ward. At all times, your nurse is there to help you, please ring your bell if you need assistance and your nurse is not near by.

Going Home

Once you have passed urine and are able to go home your nurse will advise you whether it is necessary to see your surgeon or your own doctor for follow-up.

You will be given a discharge information letter that contains helpful information for when you get home.

Your doctor may give you a prescription for some antibiotics after the operation. It is important to complete the whole course as instructed, even if you feel well and do not think they need to be finished.

It is important to drink well after your surgery, this helps prevent infection and clear up any bleeding. Any blood in the urine should clear after a few days and your urine should be a pale yellow to clear colour. For this to happen you will need to drink about 1500mls (8 glasses) of fluid a day. Water is the best fluid to drink; however, any fluid is O.K.

We will send a letter to your own doctor about your operation and the details of your treatment while you were in hospital.

Once Home

Any blood in your urine usually clears within a few days as does the stinging sensation when passing urine. Usually neither of these need treating however the fluid you drink will help to clear any blood in the urine and ural or citravescent can be used to relieve any stinging you may experience. Sachets of ural or citravescent are readily available from the chemist. Your nurse will give you further written instruction regarding these treatments prior to your discharge.

If you were a day stay patient, it is important to take things quietly for the rest of the day as the anaesthetic can still have some effects on your body.

If you are unable to pass urine, have continued burning or stinging when you go to the toilet after a few days, have any signs of a urine infection or any heavy bleeding that does not disappear, then contact your own doctor who will be happy to advise you.

While you are in hospital, we will do everything we can to make your stay as comfortable as possible. The nursing and medical staff are always available to help with whatever needs you have. If you are worried about anything before or after your surgery, or if you have any further questions or would like more information, please do not hesitate to ask your nurse who will be more than happy to help.