Stone removal surgery - ureteral stones, kidney stones (URS, FURS)

One possible form of urolithiasis is kidney stones. If kidney stones do not pass spontaneously, cause symptoms, or become stuck during passage, surgical intervention may be necessary. Smaller stones may move and travel down the ureter, causing renal colic.

In what cases is endoscopic ureteral or kidney stone removal with a ureterorenoscope (URS) or flexible ureterorenoscope (FURS) necessary?

Stones trapped in the ureter, renal pelvis or renal calyces can cause severe pain (renal colic) and obstruct the normal flow of urine from the kidney, which can lead to urinary retention. This retention can cause significant kidney damage and increases the risk of urinary tract infections, which can result in serious, feverish conditions and even life-threatening blood poisoning.

Stone removal through the urethra (ureterorenoscopy, or URS) is a minimally invasive procedure that allows direct visualization of the urinary tract without incisions, enabling accurate assessment of the location, size and shape of the stone. During the procedure, the stones are pulverized or removed using special instruments, such as a stone basket or laser. Fragmentation via laser is necessary if the stones are too large to pass naturally. Small pieces of stone may remain after the procedure, but these will pass naturally within a few days.

The renal cavity system cannot be accessed with a traditional ureteroscope. When we want to remove stones from the kidney (for example during surgery to remove stones from the ureter), it is necessary to use a flexible ureterorenoscope. With this device, we can examine the entire renal system, ensuring that no stones remain which could cause problems after surgery. The aim is to ensure complete stone removal and accurate diagnosis.

What preliminary tests are required?

Prior to ureteral or kidney surgery for stone removal, in addition to a urological examination, a laboratory test, urine culture and an anesthesiologist's examination are required. Before surgery, we almost always request a CT scan to determine the exact size, location and hardness of the stone. Other additional tests (e.g., renal isotope scan, contrast medium injection, cystoscopy) are rarely necessary, except in special cases.

How should you prepare for the procedure?

In certain cases, your doctor may decide that the ureter needs to be treated with medication or that a temporary stent (double-J catheter) needs to be inserted. If this is necessary, we will inform you of this, otherwise no special preparation is required for the surgery.

How is endoscopic ureteral and kidney stone removal performed using a ureterorenoscope?

The procedure is performed under general anesthesia or spinal anesthesia. During the surgery, an optical examination device (ureterorenoscope) is inserted through the urethra into the bladder, then into the ureter, and if necessary, all the way to the renal pelvis and renal calyces (in this case, a flexible ureterorenoscope is used). Once in the bladder, the opening of the affected ureter is dilated with stiffening wires so that the device can be inserted safely. During the procedure, x-rays may be used to monitor the process. For this purpose, a contrast agent is injected into the ureter and renal pelvis to visualize the urinary tract and accurately identify pathological changes, such as stones. The stones found are broken up with a laser, and the broken pieces are removed with special instruments. Smaller stones can be removed without being broken up. After the procedure, it may be necessary to insert a ureteral and/or urinary catheter to ensure the flow and drainage of urine.

At our Private Hospital, flexible ureteroscopy is currently performed using the most modern technique, with a negative-pressure, flexible, single-use working channel and a digital, chip-on-the-tip single-use ureterorenoscope. This solution significantly reduces surgical time and the risk of infection and increases stone clearance. In certain cases, it is even possible to remove larger, multiple stones.

Advantages of endoscopic stone removal

Endoscopic procedures are less invasive because they do not require opening the body cavity. Patients recover more quickly and experience less pain. The risk of bleeding and complications is also lower, making them a safer option for older patients or those with chronic conditions.

However, in the case of larger stones (2-3cm) or complex, multiple kidney stones, ureteroscopic surgery can be significantly more time-consuming, which increases the risk of complications. Due to the long surgical time, anesthesia may also place a greater burden on the patient. In such cases, percutaneous nephrolithotripsy (PCNL) is recommended.

The advantages of laser stone surgery

For stone removal surgery, we have a high-performance holmium laser generator at our disposal, which allows us to easily pulverize even the hardest stones. The use of laser speeds up stone removal and makes it more flexible, thus ensuring a higher stone clearance rate.

What should you do after endoscopic ureter and kidney stone removal?

After the procedure, patients usually stay in the hospital for one day. The urinary catheter and bladder catheter inserted during the surgery are removed the day after the surgery. After the procedure, it is important to drink plenty of fluids and rest. Activity can gradually increase over the following days, but strenuous activities and heavy lifting should be avoided for approximately 2-6 weeks. After the surgery, a temporary ureteral stent (double-J catheter) may be left in place, which your doctor will remove at a specified time.

We recommend metabolic testing for patients at high risk of recurrent kidney stones or subsequent stone formation. This consists of a 24-hour urine collection and laboratory testing. The examination may reveal hidden diseases (e.g., hyperparathyroidism, renal ion imbalance), the treatment of which can significantly reduce the risk of recurrent kidney stones. Since every kidney stone is different, the tests must be tailored to the individual.

What are the risks associated with the procedure?

In the first few days after the procedure, urination may be painful due to irritation of the bladder and urethra, and there may be a small amount of blood in the urine, as well as more frequent urination.

Bacterial inflammation, scarring leading to narrowing, allergic reactions and deep vein thrombosis may also occur, but the chances of these are minimal if the appropriate protocols are followed.

Fees for endoscopic ureteral and kidney stone removal with a ureterorenoscope

You can find our current fees under our prices menu.

WHY CHOOSE DR. ROSE PRIVATE HOSPTAL? 

• Highly trained specialists, modern diagnostic and therapeutic equipment.
• Empathetic, people-centered approach. Our specialists always keep the comfort and safety of our patients in mind.
• Premium inpatient department. Available to our patients are 4 operating theaters and 44 patient rooms with 54 beds to meet all needs. The highest professional standards are combined with an exclusive environment that aids recovery in safety and with complete peace of mind.
• Fast and predictable appointments. We provide an appointment for the necessary intervention within 1-2 weeks of the first specialist consultation.

For all your urological complaints, please contact the doctors at Dr. Rose Private Hospital with confidence.