Endoscopy
for kidney stones
What is urinary endoscopy? | The equipment of the operating room | Is general anesthesia safe?
How is endoscopy performed for ureter stones? | How is endoscopy performed for kidney stones?
What is percutaneous nephrolithotripsy? | What is the double J stent? | How is recovery after kidney stone surgery?
What is urinary endoscopy?
The available surgical technology allows us to treat virtually all cases of urinary stones by endoscopy, that is, through a micro-camera that navigates through the urine system.
Endoscopic or minimally invasive surgery consists of a procedure performed in the surgical center, with anesthesia, observing all the safety protocols of conventional surgery. It also has a faster and less painful postoperative recovery.
Considering the low risk and rapid recovery, endoscopic urinary lithiasis treatment has become an option for impacted stones as well as a more comfortable pathway for patients with stones that can be eliminated spontaneously but wish to avoid the symptoms of severe pain renal colic.
The equipment of the operating room.
Our surgical center has a radiolucent surgical table that allows visualization of images by radiography of the abdomen in real time (radioscopy), endoscopic equipment and, in most cases, the stone itself can be seen by transoperative radioscopy.
The fragmentation of the stone occurs by lithotripsy to LASER through the Uropulse Dornier MedTech system or by ultrasonic lithotripsy by the Calcuson Karl Storz system. In both cases the stones are broken through a source of energy, turning into fragments that can be removed by extracting probes or eliminated naturally by the urine.
Urologists navigate the urinary system by looking at optical lens systems that transmit the images to a high definition monitor that increases the size of structures by up to 16 times. In this way, even small fragments of urinary calculi can be identified.
EndoUro's Operating room
at Hospital Baía Sul in Florianópolis
Anesthesia with the aid of the video laryngoscope by Karl Storz
Is general anesthesia safe?
We often tell patients that general anesthesia is as safe as air travel. While a pilot is ready in 3 years, the anesthesiologist needs 9 years to graduate and will likely retire with thousands of "flight hours" more than an experienced flight commander.
In addition to the fact that the medications are safe, during the anesthesia countless sensors inform all vital data in real time, alerting all members of the operating room when necessary.
General anesthesia is one of the greatest achievements in the evolution of medicine. She is, therefore, a great ally, like the airplanes.
How is endoscopy performed for ureter stones?
With the patient under anesthesia, sleeping in a position of giving birth, the urologists introduce the endoscope (surgical equipment containing a camera at the tip) through the urine channel.
After the stone is located inside the ureter, the channel that takes the kidney pee to the bladder, is made its fragmentation through a LASER fiber.
After being destroyed, the fragments of the stone are removed with the aid of an extractor that captures the debris and allows them to be brought out of the body.
The urine channel is reviewed and the procedure is terminated by the placement of a double J-stent, as a dressing within the ureter, followed by emptying of the bladder.
Ureterolythotripsy
Illustration by EAU Uroweb
Flexible Ureterolithotripsy
Illustration by EAU Uroweb
How is endoscopy performed for kidney stones?
To navigate within the kidney it is necessary to use the flexible endoscope, that is, a surgical equipment that makes curvatures allowing access to the kidney and the calyces where the calculi are formed.
Flexible endoscopy makes it possible to treat impacted stones in the ureter near the kidney or inside the kidneys, but has some limitations.
Very large stones or stones that are difficult to reach may not be treated in this way or require more than one procedure for complete resolution.
In cases where the treatment of kidney stones can not be done as flexible equipment, the best option is percutaneous nephrolithotripsy, ie navigation within the kidney with the aid of a puncture through the skin.
What is percutaneous nephrolithotripsy?
Percutaneous nephrolithotripsy is an endoscopic procedure performed through the puncture of the kidney. This puncture creates a kind of channel through which the camera is inserted and the stone is located and fragmented.
As in other techniques, a catheter is placed from the kidney to the bladder in order to promote recovery of the urinary system.
A small stitch is made at the puncture site and the scar is barely perceptible.
Percutaneous nephrolithotripsy allows the treatment of bulky kidney stones that in former times required open surgery to be removed.
Percutaneous nephrolithotripsy
Illustration by EAU Uroweb
Double J stent
Illustration of EAU Uroweb
What is the double J stent?
The double J stent is a device placed during the procedure that functions as a dressing for the urinary tract. It is made of special silicone and gets its name because both ends make a turn that resembles the letter J.
The purpose of the catheter is to keep the kidney clear as the ureter, channel between the kidney and the bladder, heals or, in some cases, until the calculus can be completely removed.
It is removed by endoscopy or through a wire that is left attached to the patient's skin and must be removed after the minimum time indicated for each case, as recommended by the urologist.
How is recovery after kidney stone surgery?
The vast majority of patients stay less than one day in hospital and are discharged in conditions to maintain normal habits such as walking, climbing and descending stairs, driving, eating and drinking the foods they are accustomed to without restrictions.
It is expected that there will be mild symptoms related to the procedure and to the double J stent.
All patients receive hospital discharge guidelines from the urology team as well as printed material with illustrations and emergency phones.
EndoUro's patient guideline