Ureteroscopy involves the use of ureteroscopes, small flexible or semi-rigid telescopes that can be inserted up the urethra, through the bladder and into the ureter without an incision. These instruments allow the doctor to view a ureteral stone directly. They also have small working channels through which various devices can be passed to remove or fragment the stone.

Urologists use ureteroscopy to remove stones that are stuck in the ureter and are closer to the bladder than the kidney (in the lower third of the ureter).

If you have a stone lodged in your ureter or have an area that needs more study in your ureter, your doctor may recommend a ureteroscopy.

If your doctor suspects a stone but is unable to make a diagnosis from a simple X-ray, he/she may scan the urinary system with intravenous pyelography (IVP). It is an imaging technique that utilizes radiopaque injections of dye followed, during excretion by the kidneys, by abdominal X-rays. A kidney obstructed by a stone will not be able to excrete the dye as quickly and may also appear enlarged when compared to the normal organ. Since this technique requires preparation, it has been replaced in many hospitals by an abdominal/pelvic CT scan, an extremely accurate diagnostic tool that can detect almost all types of ureteral stones painlessly.

Through the ureteroscope, the doctor can see the stone. The doctor can then move the stone, either by removing it with a small basket at the end of a wire inserted through an extra tube in the ureteroscope or by extending a flexible fiber that carries a laser beam to break the stone into smaller pieces that can then pass out of the body in your urine. How and what the doctor will do is determined by the location, size, and composition of the stone. The doctor may leave a stent, a flexible tube that keeps the ureter open for drainage after the procedure.

The majority of ureteroscopic procedures can be performed as day surgery and most individuals can return to work within one to two days following the procedure.

Although stone recurrence rates differ with individuals, in general you have a 50 percent chance of redeveloping stones within the next five years. So prevention is essential. Your urologist may follow-up with several tests to determine which factors - e.g., medication or diet - should be changed to reduce your further risk.

The risks of ureteroscopy include perforation or stricture (scar tissue), especially if the stone has been impacted or embedded within the wall of the ureter for longer than two months.

Complications are more likely when the stone is close to the kidney (upper third of the ureter) and include:

• Injury to the ureter.
• Urinary tract infection.
• Bleeding.
• Abdominal pain.

The ureteroscope is a special, very thin instrument used to look directly at and visualize the inside of the ureter. Some ureteroscopes are flexible like a small, very long straw. Others are more rigid and firm.

A ureteral stone is a kidney stone that has moved down into the ureter. The stone begins as a tiny grain of undissolved material located where urine collects in the kidney. When the urine flows out of the kidney, this grain of undissolved material is left behind. The material deposited is usually a mineral called calcium oxalate. Other less common materials that may also form a kidney stone are cystine, calcium phosphate, uric acid and struvite. Over time, more undissolved material is deposited and the stone becomes larger. Most stones enter the ureter when they are still small enough to move down into the bladder. From there, they pass out of the body with urination. Some stones, however, have grown larger by the time they leave the kidney. They may become lodged in a narrow part of the ureter, causing pain and possibly blocking the flow of urine. These stones may need to be treated.

Usually, the symptom of a kidney stone is extreme pain. Having been described as being worse than childbirth, the pain often begins suddenly as the stone moves in the urinary tract, causing irritation and blockage. Typically, a person feels a sharp, cramping pain in the back and in the side of the area of the kidney or in the lower abdomen, which may spread to the groin. Also, sometimes a person will have blood in the urine, nausea and/or vomiting.

In general, you are facing surgery if your stones are large enough to obstruct urine flow, if they are potentially harmful to your kidneys or if they are causing symptoms for which medication does not help.