Endoscopic Surgery for Kidney Stones

What does Endoscopic Surgery Involve?

Ureterorenoscopy and retrograde intrarenal surgery (RIRS) are the endoscopic surgeries used to treat lithiasis in the urinary tract.

In this technique, a ureteroscope is used that can be semi-rigid or flexible and is inserted through the urethra to fragment and remove any “stones” in the bladder, ureters or kidneys.

Kidney stones are fragmented with a laser that works via a very narrow fibre optic cable. This cable is inserted through the ureteroscope. Surgical instruments may also be used to remove the stone fragments. For example, very small special tweezers and baskets inserted through the middle of the ureteroscope.

Endoscopic surgery is a highly effective procedure to eliminate lithiasis without resorting to open surgery.

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What is the Procedure for Endoscopic Kidney Surgery?

This urological surgery is performed under general anaesthetic and is able to treat most cases of urinary stones.

The procedure is conducted by a video monitor which allows images to be shown via a microcamera at the end of the ureteroscope.

The procedures can vary slightly depending on the location of the stone and its size and composition

Endoscopic Surgery for Ureteral Stones

A semi-rigid ureteroscope is generally used with a hole through which instruments like guide-wires, tweezers or baskets are inserted to remove the stone, as well as the laser cable to fragment the stone.

As soon as the stone is located, lithotripsy is performed, i.e., the stone is fragmented into smaller pieces which are then removed with the help of an extracting tool.

Endoscopic Kidney Surgery

In this technique, a flexible ureteroscope is generally used with the same types of tools – guide-wires, tweezers, baskets, laser – though even smaller than those used with the semi-rigid ureteroscope.

If the stone is very big or cannot be removed with the aforementioned tools, a percutaneous nephrolithotomy is necessary.

Percutaneous Nephrolithotomy

This surgical procedure is performed by puncturing the kidney through the back with the patient under general anaesthetic.

After puncturing the kidney, a channel with a calibre of less than 1 cm is created through which an instrument called a nephroscope is inserted. Devices to fragment the stone and then remove the fragments are then introduced.

This technique is used when stones are larger than 20 mm or there are several of them.

Percutaneous nephrolithotomy is not recommended when the patient has a urinary infection or coagulation changes (due to the risk of sepsis and haemorrhage, respectively).

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What is the Post-Treatment for Endoscopic Surgery?

If there are no post-operative complications, hospitalisation for endoscopic surgery is usually one day.

Normally, patients can return to their normal lives in the days following surgery without any restrictions.

After these treatments, patients must be followed up with tests to monitor the clinical evolution, initially every 6 months and then annually for around 5 years. If there is a recurrence and more stones occur, the procedure may need to be repeated or shockwave lithotripsy (SWL) performed. The follow-up may be prolonged.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

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