ureteroskopia

Ureteroscopy is an endoscopic examination of the ureter and the renal collecting system performed with a ureteroscope inserted through the urethra, into the bladder, and up the ureter. It can be used for diagnostic purposes or to perform a variety of therapeutic interventions. There are two main types: rigid ureteroscopes, which are straight and best for distal ureteral visualization, and flexible ureteroscopes, which can navigate the entire upper urinary tract.

Indications include evaluation of hematuria of unclear origin, suspected or known stone disease, ureteral strictures, urothelial tumors, and obstruction. Therapeutic uses include fragmentation and retrieval of stones using laser lithotripsy (often Holmium:YAG) or baskets, dilation of strictures, stent placement, and obtaining targeted biopsies of the urothelium.

Technique typically involves anesthesia, cystoscopic access to the ureteral orifice, insertion of a guidewire, and sometimes an access sheath to facilitate repeated entries. The ureteroscope is advanced to the area of interest under saline irrigation for visibility. Procedures may be purely diagnostic or combined with treatment, and postoperative stenting is common to support healing.

Outcomes and benefits include direct visualization of the ureter and renal pelvis, the ability to treat stones in situ, and high stone-free rates for selected stones, especially with flexible ureteroscopy. Complications are relatively uncommon but can include infection, ureteral injury or perforation, bleeding, ureteral stricture, and, rarely, ureteral avulsion or sepsis.

Alternatives vary by condition and may include extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, or imaging-guided approaches.