Ureteroscope for Removing Kidney Stones

A ureteroscope is a specialized device used by urologists in one of the main procedures for either removing or smashing kidney stones. It's tiny, thin and goes places many of us would prefer not to think of. But it uses plenty of technology to get this sensitive job done.

Ureteroscope

• A ureteroscope is a long, wire-like object used in ureteropyeloscopy (or laser lithotripsy), one of the main procedures for the removal of kidney stones. A very thin instrument, it's used to look at the inside of the ureter, the bodily channel that moves urine between the kidney and bladder. The ureteroscope includes a tiny camera and light as well as an extra tube through which physicians can pass another minuscule wire. This latter contains either a fiber-optic laser to disintegrate the stone or a second wire with a small basket at the tip with which to remove the kidney stone.

Past

• Dr. Michael Grasso, chairman of the Department of Urology at Saint Vincent's Medical Center in New York, says the ureteroscope was originally used as more of a diagnostic tool to help determine strategy in stone removal. However, it's now evolved to be a therapeutic device with little risk of side effects or potential damage. In layman's terms, doctors previously utilized it to figure out what was wrong and where the stones were. Now they use it to either smash the kidney stones or remove them. Best of all, it works very well.

Types

• Ureteroscopes come in two varieties, semi-rigid and flexible. The flexible version could be described as similar to a bending, thin straw. Semi-rigid devices are rarely used as the newer, flexible instrument allows for much easier access through the urinary system's tiny and sharp angles. In addition to kidney stones, ureteroscopes are used to treat a variety of upper urinary tract problems including urothelial (the tissue that lines the urinary tract) malignancies, stricture disease and bleeding lesions.

Procedure

• A urologist inserts the ureteroscope into the patient's urethra. As it is fed in, it is moved through the bladder to the stone inside the ureter where the doctor can view the mass through the small camera in the scope. He or she then chooses whether to remove it or to smash it with an ultrasonic laser. This latter option primarily applies to stones that are trapped in the ureter on their journey to the bladder.

  Performed under general anesthesia, the method requires one to three hours of procedure time with no hospital stay. Georgetown University Hospital urologists note that "this procedure allows for the option of pushing the stone back into a region where ESWL is better suited."

  Extracorporeal shock wave lithotripsy (ESWL) is a simpler procedure, where a machine focuses shock waves to the kidney stone, smashing it into gravel-sized bits more easily passed with urine.

New Developments

• According to Dr. Maurizio Buscarini and Michael Conlin of the Department of Urology at Oregon Science and Health University, new technology has brought digital, flexible ureteroscopes into use. These combine the digital camera and light source into one section, a definite benefit for miniaturization, as previously the two were separate. This variety of ureteroscope is likely to become the standard and holds much promise for increased reliability.