Ureteroscopy with laser (URS): treating a stone through the urine tubeLaser ke saath ureteroscopy (URS): peshab ki nali ke raste pathri ka ilaaj

Yeh kya hai aur kyun kiya jata hai

Ureteroscope aik bohat patli doorbeen hai jis mein roshni aur camera hota hai. Yeh peshab ki nali (urethra) se guzar kar bladder aur phir ureter mein upar jati hai, yani us nali mein jo gurde se peshab bladder tak le jati hai. Mudne wali qism se gurde ke andar ki pathrion tak bhi pohancha ja sakta hai. Pathri nazar aane par doorbeen ke andar se aik patli laser fibre guzaar kar pathri ko chhoti tukron mein tora jata hai.

Tukron ko ya to chhoti si tokri se nikaal liya jata hai ya woh peshab ke saath nikal jate hain. Sab kuch qudrati raaste se hota hai, is liye jild par koi cut nahi lagta.

URS aam tor par ureter ki pathrion aur gurde ki bohat si pathrion ke liye istemal hoti hai. Aap ka urologist pathri ke size, jagah aur sakhti, aur aap ki sehat ko dekh kar URS, shock wave ilaaj (ESWL), gurde ki keyhole surgery (PCNL) ya intezar mein se chunta hai (dekhein gurde ki pathri ki guide).

Procedure se pehle

• Pehle peshab ka test hota hai. Peshab ka infection ho to aam tor par operation se pehle us ka ilaaj hota hai, kyunke infection wale nizam mein operation se aap bohat bimar ho sakte hain (dekhein peshab ke tests ki guide).
• Scans: aam tor par pathri dikhane wala scan pehle ho chuka hota hai (dekhein CT scans). Apne scans aur reports saath layein.
• Khoon patla karne wali dawayein aur kisi bhi allergy ke baare mein team ko batayein. Meherbani karke apne taur par koi dawa band na karein. Aap ka urologist batayega ke kya karna hai.
• Bay-hoshi: URS aam tor par poori bay-hoshi (general anaesthetic) mein hoti hai, yani aap soye hue hote hain. Khaane peene ke baare mein jo hidayaat milein un par amal karein.
• Aap se razamandi (consent) maangi jayegi, jis mein yeh bhi shamil hai ke stent chhoda ja sakta hai. Sawalaat poochhne ka yehi waqt hai, khaas tor par yeh ke dobara procedure ki zaroorat par sakti hai ya nahi.
• Qeemat, procedure kahan hogi aur raat hospital mein rehna hoga ya nahi, yeh bhi poochh lein.

Procedure ke dauran

Poore procedure ke dauran aap soye hote hain. Camera aur kabhi X-ray ki rehnumai mein doorbeen pathri tak pohanchayi jati hai. Agar ureter tang ho to pehle use aahista se chora kiya ja sakta hai ya patli hifazati nali istemal ki ja sakti hai.

Laser se pathri tori jati hai. Bari tukron ko chhoti tokri se nikala ja sakta hai aur bohat chhoti, mitti jaisi tukrian peshab ke saath nikalne ke liye chhod di jati hain. Urologist dekhta hai ke ureter ko koi chot to nahi aayi.

Aakhir mein aksar thori der ke liye ureter mein DJ stent chhoda jata hai. Yeh ureter ko khula rakhta hai jab tak woh procedure ke baad theek hota hai. Kabhi kabhi thori der ke liye bladder mein catheter bhi rakha jata hai. Bohat se log usi din ya agle din ghar chale jate hain.

Procedure ke baad

Jo aam hai

• Peshab mein khoon, chubhan aur zyada baar peshab aana chand din tak. Bohat paani peeyein, siwaye is ke ke aap se kam karne ko kaha gaya ho.
• Stent ke ehsaasaat agar stent ho: peshab karte waqt pehlu mein dard, achanak hajat aur takleef (dekhein DJ stent ki guide).
• Chhoti tukron ke nikalne par dard. Yeh asal pathri ke dard jaisa lag sakta hai lekin halka hota hai aur aam tor par theek ho jata hai.

Normal zindagi par wapsi

• Zyadatar log chand din aaram karte hain aur halke kaam par jaldi wapas aa jate hain. Jab tak team ijazat na de bhaari kaam aur zor wali kasrat se parhez karein.
• Gaari chalane, kaam aur safar ke baare mein team se poochh lein. Bay-hoshi ke baad pehle din gaari na chalayein.
• Aam dard kam karne wali dawayein, aur kabhi ureter ko dheela karne wali dawa, team ke mashwaray se istemal karein.

Mumkina khatrat

• Aam: peshab mein khoon, chubhan, zyada baar peshab aana aur stent ki takleef.
• Kam aam: peshab ka infection, tukron ke nikalne par dard, aur pathri ke bache hue tukre jin ke liye mazeed ilaaj ya doosra procedure chahiye ho.
• Bohat kam: ureter ko chot, baad mein ureter ka tang ho jana, khoon mein phailne wala shadeed infection, ya pathri tak aik hi baar mein na pohanch paana.

Kabhi pathri bohat sakht ya mushkil jagah par hoti hai aur aik hi session mein poori nahi hoti. Aisi surat mein urologist stent laga kar doosra procedure tay kar sakta hai, jo aik mehfooz aur aam tareeqa hai.

Stent, nateeje aur follow-up

• Agar stent hai to use waqt par nikalwana ya badalwana zaroori hai. Ghar jane se pehle tareekh poochh lein, aur agar na mile to us unit se khud raabta karein (dekhein DJ stent ki guide).
• Pathri ka tajzia: pathri ke tukre laboratory bheje ja sakte hain taake pata chale ke pathri kis cheez ki bani thi. Poochh lein ke nateeja aap ko kaise bataya jayega (dekhein 24 ghante ka peshab aur pathri ka tajzia).
• Jaanch ka scan: aksar baad mein scan tay hota hai taake yaqeen ho jaye ke koi pathri baqi nahi.
• Nayi pathri se bachao: kaafi paani peena sab se ahem qadam hai. Aap ka urologist mazeed mashwaray de sakta hai (dekhein gurde ki pathri ki guide).

Aam sawalaat

What it is and why it is done

A ureteroscope is a very thin telescope with a light and a camera. It is passed along the urine tube (the urethra), through the bladder and up the ureter, the tube that carries urine from the kidney to the bladder. A flexible type can also be bent to reach stones inside the kidney. When the stone is seen, a thin laser fibre is passed through the telescope and used to break the stone into small pieces.

The pieces are either picked out with a tiny basket or left to pass in the urine. Because everything goes through the natural passage, there are no cuts on the skin.

URS is commonly used for stones in the ureter, and for many stones in the kidney. Your urologist chooses between URS, shock wave treatment (ESWL), keyhole kidney surgery (PCNL) and waiting, depending on the size, position and hardness of the stone, and on your own health (see the kidney stones guide).

Before the procedure

• A urine test is done first. A urine infection is normally treated before the operation, because operating on an infected system can make you seriously unwell (see the urine tests guide).
• Scans: you will usually have had a scan to show the stone (see CT scans). Bring your scans and reports.
• Tell the team about blood thinners and any allergies. Please do not stop any medicine on your own. Your urologist will tell you what to do.
• Anaesthetic: URS is usually done under general anaesthetic, so you are asleep. Follow the instructions about eating and drinking.
• You will be asked for consent, including agreeing that a stent may be left in. This is the time to ask questions, including about a possible second procedure.
• Ask about the cost, where it will be done and whether you will stay in hospital overnight.

During the procedure

You are asleep for the whole procedure. The telescope is passed up to the stone, using the camera and sometimes X-ray to guide it. If the ureter is narrow, it may first be gently widened or a thin protective tube used.

The laser is used to break the stone. Larger pieces may be picked out with a tiny basket, and small dust-like pieces are left to pass in the urine. The urologist checks that the ureter has not been injured.

At the end, a DJ stent is often left in the ureter for a short time. It keeps the ureter open while it settles after the procedure. Sometimes a catheter is left in the bladder for a short time. Many people go home the same day or the next day.

After the procedure

What is normal

• Blood in the urine, stinging and passing urine more often for a few days. Drink plenty of water unless told otherwise.
• Stent symptoms if a stent is in: an ache in the side when passing urine, urgency and discomfort (see the DJ stent guide).
• Pain as small pieces pass. This can feel like the original stone pain, but milder, and usually settles.

Getting back to normal

• Most people rest for a few days and return to light activity quickly. Avoid heavy work and strenuous exercise until the team says it is safe.
• Ask the team about driving, work and travel. Do not drive on the first day after an anaesthetic.
• Use simple pain relief, and sometimes a medicine that relaxes the ureter, as the team advises.

Possible risks

• Common: blood in the urine, stinging, passing urine more often, and stent discomfort.
• Less common: a urine infection, pain as pieces pass, and leftover stone pieces that need more treatment or a second procedure.
• Rare: an injury to the ureter, a narrowing of the ureter later on, a serious infection that spreads into the blood, or not being able to reach the stone in one go.

Sometimes the stone is too hard or too awkward to finish in one session. The urologist may then place a stent and plan a second procedure, which is a safe and common approach.

Stent, results and follow-up

• If you have a stent, it must be removed or changed on time. Ask for the date before you leave and contact the unit yourself if you have not been given one (see the DJ stent guide).
• Stone analysis: pieces of stone may be sent to the laboratory to find out what the stone is made of. Ask how you will be told the result (see 24-hour urine and stone analysis).
• Check scan: a follow-up scan is often arranged to make sure no stone is left behind.
• Preventing new stones: drinking enough water is the main step. Your urologist may suggest more (see the kidney stones guide).

Common questions