What is flexible ureterorenoscopy?
Flexible ureterorenoscopy is an advanced endourology technique that allows access to the inside of the kidney and ureter through the natural passages, without the need for skin incisions. We use a thin, flexible endoscope, equipped with a high-definition camera and laser fiber, to locate and fragment kidney stones. This procedure is the preferred option for medium-sized stones or those located in difficult-to-reach areas of the kidney, where other techniques are not effective.
In what cases is this technique indicated?
As head of the Lithiasis and Endourology team at iCUA, I primarily recommend this surgery for kidney stones up to 2-3 cm in size, especially those located in the lower calyces of the kidney, where gravity hinders spontaneous expulsion. It is also the treatment of choice when extracorporeal shock wave lithotripsy has failed or when the patient requires a definitive solution in a single session. The instrument's flexibility allows us to navigate the entire renal anatomy to ensure that no fragments remain.
The step by step procedure
The procedure is performed under general anesthesia and usually lasts less than 60 minutes, although it may take slightly longer in complex cases. The process is as follows:
- Access: We insert the flexible ureteroscope through the urethra and bladder until we reach the ureter and kidney.
- Location: Thanks to direct vision, we accurately identified the calculation.
- Fragmentation: We use laser energy (holmium or thulium) to pulverize the stone into powder or tiny fragments.
- Extraction: The fragments are extracted with a special basket or left to be expelled naturally.
- Sewer system: In most cases, we place a temporary double J catheter to facilitate healing and urine drainage.
Recovery and advantages compared to other techniques
Because there are no external incisions, postoperative pain is minimal and recovery is very quick. Most patients are discharged within 24 hours. Key advantages include no scarring, a lower risk of bleeding, and a faster return to work. Unlike percutaneous nephrolithotomy, which requires a small incision in the back, flexible ureterorenoscopy is entirely internal. For more details on other surgical options, please see [information on] HoLEP: the laser technique that solves enlarged prostate without open surgery, another cutting-edge laser technique that we offer at our center for different urological pathologies.
iCUA team experience
At the Institute of Advanced Urological Surgery (iCUA), we perform over 50 endourology procedures annually in our kidney stone program. As Head of the Urology Department at the University Hospital of Getafe and Professor of Endourology at the Jesús Usón Minimally Invasive Surgery Center, I guarantee that every case is meticulously planned. We utilize state-of-the-art technology, such as suction sheath access, to improve visibility and the success rate in removing complex stones.
FAQ
Does flexible ureterorenoscopy hurt?
The procedure is performed under general anesthesia, so the patient feels no pain during surgery. After the procedure, it is normal to experience mild discomfort when urinating or in the lower back, especially if a double-J stent is left in place, but these symptoms are easily managed with prescribed pain medication.
How long will I need to be admitted?
Hospital discharge usually occurs 24 hours after the procedure. In very simple cases, we could even consider same-day discharge, depending on the immediate recovery and the anesthetic protocol.
What is a double J stent and when is it removed?
It is a thin, flexible tube that we temporarily place between the kidney and the bladder to keep the ureter open and facilitate the passage of urine and small fragments of kidney stones. It is removed in the outpatient clinic, usually between 7 and 15 days after surgery, through a quick and simple cystoscopy.
Can I lead a normal life after the operation?
Relative rest is recommended for the first 2-3 days. You can resume your normal work activities in less than a week, avoiding strenuous physical activity until the double J stent is removed and your urologist has given you the go-ahead.
