Kidney Stones and Ureteroscopy - Everything you need to knowSep 03, 2022
hi, i'm dr. mark greenstein with advanced urology and today we are going to talk about
ureteroscopyis a very common surgery that we do in the world of urology it is the standard of care treatment for small to medium
stonesand ureters so first let's go over a little bit of anatomy first you have a kidney the kidney is the organ that filters the blood to remove some of the toxins and is what produces urine you have the ureter the ureter is the tube that connect the bladder and the kidney and then you have your bladder the bladder is the organ that stores urine so you can then go to the bathroom and get rid of those toxins now that the salt, minerals and protein are getting a bit out of hand in the urinary system which is where kidney stones form the most common kidney stone is called calcium oxalate the second most common stone is uric acid and then there are other things like calcium phosphate magnesium ammonium phosphate p stones etc etc now the classic symptom of a kidney stone is doc it hurts here radiates to my forehead and im going to throw up in that toilet right there some people will have a fever some will have chills. people will pee a little bit of blood a lot of people will just end up in the ER now in some people they may not have all of those symptoms lately i've had a lot of people just get blood in their urine or some people who they just have nausea or they just have this dull ache under their ribcage there are two ways to diagnose a kidney stone there are actually many ways to diagnose kidney stones let's be honest but there are two main ways one is an ultrasound the other is a cat CT scan CT scan is the gold standard.
The CT scan tells us exactly where they are. The CT scan tells us how big they are and the CT scans tell us if they are blocking the kidney. In advanced urology, we tend to do a lot of ultrasounds because they are safer. they are quicker and less expensive if someone has a complicated stone or we
needmore answers that's when I'm going to jump in and do a CT scan but the ultrasound will tell me where the stones are if the kidney is swollen and if the kidney you have a lot of trouble now suppose you have stones in your ureter that are causing a blockage so we will see reports saying six millimeter stones in the middle of your ureter with hydronephrosis hydronephrosis means kidney water hydronephrosis if that happens we are certainly going to try medical therapy so he can get the stone out then we'll put him on hydration give him pain relievers like seam spricks tramadol or oxycodone we'll give him a medicine called tamsilosin which is flomax it helps relax the ureter that's the tube that connects the kidney and bladder so you can try to pass these stones but if you can't then it's time we jump in and like I say go fishing r and that's when I'm going to bring someone into the operating room they're going to get an IV they're going to get antibiotics they take them back to the room and then I'm going to look inside so first we start by looking inside the bladder many times I'm going to do an x-ray of the kidney so I can look at the anatomy see where the stones are located and then I'm going to put a ureteroscope so it's a little scope in the ureter and look down into the kidney if the stone is in the ureter many times we can take a laser fiber and literally play asteroids and just break the stone which turns to dust we can either take out the stones or just let your own body remove the debris and then we put in a stent when we're done and we'll talk about stents in a second.
If the stones are in the kidneys, we're going to go up to the kidney and we're going to play one more time with asteroids and hit all these stones and literally turn them to dust once. again when we are done we put a stent in the kidney now the stents are strong the stents are not the best in the world but they guarantee that the kidney will drain and as long as the kidney will drain you will be healthy you may not feel well but you are going to have a healthy kidney the stents will cause urgency to urinate frequency you may have a little bit of constipation from that no doubt you will have some back pain and the back pain is mostly when you urinate why what's that? because when you urinate some of that urine goes up that stent when your body is not used to that and your kidneys might be like oh that didn't feel very good and you will certainly see some blood in your urine please don't let that none of this scares you it's just part of the business but we'll give you medicine to help we'll give you stuff to burn some antibiotics some pain reliever whatever you
neednow this is the hard part some people bring us very small ureters and we can't
knowuntil we get it let's get to the operating room no ct scan mri whatever the s is going to tell us the size of the ureter and the ureter is basically that it can be the size of spaghetti but a lot of ureters give us a little bit of a stretch , they stretch, they dilate and many times we can take the cameras where we need them for the first surgery. but somewhere around five percent of the cases we can't get the camera where it's going, so what we'll do is we'll put in a stent, we'll say we're trying and then over a period of about four five six seven days that ureter, which it's pretty thin now it's going to stretch and it's going to allow the camera to go in and out in a second so very commonly we'll bring people back into the operating room and do what I describe a second look ureteroscopy here is where i bring you back once again you go unconscious we give you antibiotics again we take the camera and look right at the kidney and the ureter and like i said once the stent is in the ureter it dilates nicely and we can get that camera inside my analogy think of it as a square peg in a round hole sometimes you can make the square peg fit but a long time but sometimes you can't now once we get it all straight that's when it s Pull the stent out a lot of times we'll put this in we'll do the stone surgery on we'll call it day one and a week later we'll clean out the extra stones we'll use a laser again sometimes sometimes we'll get some stones out in a basket and we can get the stent out usually a week later now sometimes we can't sometimes people get sick sometimes people have a lot of stones in there we need the body to relax some people bring us an infection when they first got the stent in other words they had a kidney infection we need that kidney to calm down and then wait, we'll wait a couple of weeks and then we'll clear them up, but that's basically your lectoroscopy to separate the kidney stones.
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