Ureteroscopic

Ureteroscopy is a urological procedure in which a small-caliber endoscope (ureteroscope) is inserted through the urethra, bladder, and into the ureter to visualize the ureter and kidney. It allows direct inspection of the upper urinary tract and can be diagnostic or therapeutic.

During the procedure, a rigid or flexible ureteroscope is navigated with the aid of a guidewire. An optional ureteral access sheath may be used to facilitate multiple entries and protect the ureter. Stones are fragmented using laser lithotripsy, commonly holmium:YAG, or other instruments and then retrieved with endoscopic baskets. In intrarenal cases, a flexible scope may be advanced into the calyces to target stones or lesions. Irrigation maintains visibility, and postoperative stenting is sometimes employed to promote drainage and healing.

Indications include management of ureteral and intrarenal stones, evaluation of hematuria, assessment of ureteral strictures, and biopsy or evaluation of upper tract tumors. It is frequently used as retrograde intrarenal surgery (RIRS) for stones that are not easily treated with extracorporeal lithotripsy or other modalities. The approach is adaptable for adult and pediatric patients, with appropriate equipment for smaller anatomy.

Outcomes and risks: stone-free rates depend on stone size, location, and composition but can be high for selected cases. Ureteroscopy is generally less invasive than percutaneous nephrolithotomy for intermediate-sized stones. Complications include ureteral injury or perforation, infection or sepsis, ureteral strictures, and bleeding. Postoperative stents are common in many cases; antibiotic prophylaxis is advised, and the procedure is avoided in the presence of active infection or certain anatomic contraindications.