Ureteroscope – Working Principles, Advantages and Uses

Ureteroscopy is a procedure under general anesthesia. You may want to ask someone to drive you home after the procedure. Before ureteroscopy, you should take medicine to help prevent an infection. A ureteroscope is a device used in carrying out ureteroscopy

The ureteroscope tip is subject to damage, which requires frequent repair. Such repairs are costly. Hence, there is interest in estimating repair cost per ureteroscopy.

Working Principles of a Ureteroscope

The ureteroscope is a flexible endoscopic instrument which can be used to access the urethra, bladder and ureters. It is an essential tool in the endourologic armamentarium and provides high efficacy and low morbidity in the management of renal stones. The ureteroscope is an important component of the lithotripsy system and can be used for fragmentation, disintegration and removal of the stone.

In order to avoid damage to the ureteroscope, it should not be pushed or pulled vigorously during insertion and use. It is also important to drain the bladder before inserting the scope and to ensure that the ureteroscope can easily pass through the urinary tract without compression or kinking.

Ureteroscopes can be semi-rigid or flexible and are available in a variety of sizes from 7 to 12 Fr, with varying working channel diameters. Larger, often dual, working channels allow for better irrigation and facilitate the insertion of larger accessory instruments like baskets.

Material Used in making a Ureteroscope

Modern ureteroscopes are made from stainless steel and incorporate advanced fiber-optic technology. This allows for improved lighting, higher resolution imaging and greater versatility and durability. These newer models can be used for a variety of applications including diagnostic, therapeutic and cystoscopic ureteral procedures.

Disadvantages of Using Ureteroscope

One of the greatest obstacles to using ureteroscopes is their relative fragility. Infections resulting from the improper cleaning and sterilization of endoscopic instruments continue to be a significant concern for healthcare providers. This is particularly true with ureteroscopes which are frequently used in the treatment of urological conditions.

A good ureteroscope should be well lubricated prior to insertion, and a standard 0.035 guidewire may be used as a “railroad” to help navigate the scope into place. Care should be taken not to over-stretch the ureteroscope during insertion as this can strip its protective coating, leading to future stone formation.

Once a ureteroscope is placed in the correct position, fluoroscopic imaging can be used to monitor progress. The ureteroscope should be inspected at least once in each calyx to verify correct positioning and avoid unnecessary manipulation. A second fluoroscopic image should be obtained after the ureteroscope has been in place for an extended period of time to check that it is not looping or a kink has occurred.

Uses of Ureteroscope

The most common use of a ureteroscope is to treat kidney stones, but it can also be used to diagnose other problems, such as an infection or tumor. The doctor can then remove the problem with a basket on the end of the scope, or break up the stone with a laser. A ureteroscope can also be used to remove a cyst, or to place a ureteral stent in the kidney.

The ureteroscope can be inserted into the urethra or bladder, and then into the ureter. It can be straight and stiff (called a rigid cystoscope) or it can bend, like a telescope. Most doctors use a flexible ureteroscope because it is easier to control. The ureteroscope can be guided by a guide wire, or a safety wire preloaded into the scope. The bladder should be drained before insertion of the ureteroscope, to prevent undue intramural ureteral compression.

A ureteroscope can also be guided by an assistant or by the surgeon’s hands. The ureteroscope can be used to collect samples of the kidney, such as biopsy specimens, or to break up and remove polyps. It can also be used to treat urinary infections, such as a pyelonephritis. It is also used to remove stones from the kidney and urethra. The procedure is performed under general anesthesia.

Risks Associated With Ureteroscopy

There is a small risk of bleeding or injury to the ureter during a ureteroscopy. There is also a chance of an infection in the area where the ureteroscope was inserted. You may have pain when you pee for a few days after the procedure.

The LithoVue Single-Use Digital Flexible Ureteroscope is designed to simplify the URS procedure, with high-resolution digital images and easy maneuverability. It eliminates the cost and hassle of reusable ureteroscopes, which can require extensive reprocessing, resulting in inconsistent performance and potential for contamination.3-4 It also saves time and money by eliminating the need for post-procedure reprocessing.4-7 The unique, single-use design of the lithoscope means fewer steps for sterilization, and less downtime due to scope failure. This can reduce operating room costs, and it can improve clinical outcomes by allowing you to treat more patients per day.

Diagnosis Using Ureteroscope

Ureteroscopy can help diagnose and treat problems in your kidneys and ureters, like a stone. You may need to have a stent placed to keep the kidney and ureter open after a ureteroscopy. It takes 30 minutes to two hours and is done as an outpatient procedure. You will be under sedation during the procedure. If you have a fever or chills after the surgery, tell your doctor right away. This could be an infection.

Repair of a Ureteroscope

The fragility of flexible ureteroscopes has been a source of significant concern in the urology community. In fact, many high profile studies have shown that a single scope can require repair in as few as six cases. These repair costs have the potential to derail a practice’s profitability.

To determine if optimizing reusable ureteroscope’s durability can reduce repair rates and associated costs, scientists examined data from a 3-year cohort study of 655 patients undergoing ureteroscopies using five Olympus URF P5 flexible ureteroscopes. Patient demographics, operative time, size of stone and use of laser or ureteral access sheath were recorded. The authors found that scope damage occurred in 28 patients. On univariate analysis, shorter patient height, absence of safety guidewire, longer operative time, use of lithotripsy and surgeon concern were associated with scope repair. In addition, degree loss of upward ureteroscope flexion was an independent predictor of scope repair on multivariate analysis.

After your ureteroscopy, you may have to leave a stent in place for one or two weeks to help the kidney and ureter heal and drain properly. Your doctor will explain what was seen during the ureteroscopy and what treatment, if any, you need. It is important to drink two eight-ounce glasses of water each hour after a ureteroscopy for the first two days. If you have pain or chills, or if the stent becomes painful, talk to your healthcare provider. Infection after a ureteroscopy can be serious, so it is very important to follow your doctor’s instructions about taking antibiotics. Your doctor will also give you other tips about how to prevent infections after a ureteroscopy.

Maintenance of a Ureteroscope

A ureteroscope is used to look at the ureters and kidneys under general anaesthesia. The doctor will use a small instrument to grab and break up kidney stones or take them out through your bladder. They can also put in a small stent to allow your urine and the stone to pass through the ureter. This will be left in place until the stone passes or your urologist sees that it has been removed. This can be done in hospital or in your GP surgery.

Ureteroscopy is a safe procedure but there is a small risk of infection. There is also a slight chance of injury to the ureter or urethra. This can cause pain and swelling when you pee. You will need to drink lots of water before the test.

Reusable ureteroscopes can be damaged and need repairs after 10 to 20 procedures. This has led to the development of disposable ureteroscopes. These can be cheaper than reusable scopes and do not require expensive repairs. They have been shown to improve the image quality of flexible ureteroscopes. They also provide a better deflection capacity and can be withdrawn more easily.

Despite these advantages, disposable ureteroscopes are not as widely used as reusable ones. This may be due to concerns about their cost, durability and complication rate. However, recent studies have demonstrated that they are comparable to reusable ureteroscopes.

It is important to make sure that you get your medication and take any antibiotics that are prescribed to you. You should also tell your doctor if you have any allergies to medications.

If you are having a ureteroscopic procedure, you will need to make sure that you can have someone drive you home afterwards. You will need to drink 4 or 6 glasses of water before the operation.

Flexible ureteroscopes can be used to collect biopsy samples, remove polyps or treat blockages. They are also used to treat ureteral stones and are an essential tool in the diagnosis of kidney stones. During the procedure you will need to lie down and you will be given a general anaesthetic so that you don’t feel any pain. Before the procedure you will need to attend a pre assessment clinic where you will be screened for MRSA and a few baseline investigations will be carried out.