Kidney Stones and Ureteroscopy - Everything you need to know

Advanced Urology
14 Dec 202007:33
EducationalLearning
32 Likes 10 Comments

TLDRIn this informative video, Dr. Mark Greenstein, a urologist, explains the procedure of ureteroscopy used to treat small to medium-sized kidney and ureteral stones. He begins by outlining the anatomy involved, including the kidney, ureter, and bladder, and then describes the common types of kidney stones. Dr. Greenstein details the typical symptoms experienced by patients and the diagnostic methods, emphasizing the CAT scan as the gold standard. He discusses medical therapy options and the surgical approach involving the use of a ureteroscope and laser to break stones into smaller pieces that can be passed or removed. The importance of stents in ensuring kidney drainage is highlighted, along with the potential side effects and the follow-up procedures that may be necessary. The video concludes with the process of removing the stent and addressing any residual stones, providing a comprehensive overview of managing kidney stones through ureteroscopy.

Takeaways
  • 🩺 **Ureteroscopy Definition**: Ureteroscopy is a common urological surgery used to treat small to medium-sized kidney and ureteral stones.
  • 🔍 **Anatomy Overview**: The urinary system includes the kidneys (filters blood and makes urine), ureters (tubes connecting kidneys to bladder), and bladder (stores urine).
  • 💠 **Kidney Stone Types**: Calcium oxalate is the most common kidney stone, followed by uric acid, and others like calcium phosphate and magnesium ammonium phosphate.
  • 😖 **Symptoms**: Kidney stones cause severe pain that may radiate to the front, nausea, and sometimes fever, chills, or blood in urine.
  • 🏥 **Diagnosis Methods**: Ultrasound and CT scan are the primary methods for diagnosing kidney stones, with CT scan being the gold standard.
  • 💊 **Medical Therapy**: For small ureteral stones causing blockage, medical therapy includes hydration, pain medication, and a muscle relaxant like tamsulosin (Flomax).
  • 🛠️ **Surgical Procedure**: If medical therapy fails, ureteroscopy involves inserting a tiny scope into the ureter to locate and break stones with a laser fiber.
  • 🤽‍♂️ **Stent Placement**: A stent may be placed after surgery to ensure the kidney drains properly, which can cause discomfort and urgency to urinate.
  • 🔄 **Second Look Ureteroscopy**: In about 5% of cases, the initial ureteroscopy cannot clear the stones due to small ureters, requiring a second procedure after the ureter dilates.
  • ⏱️ **Stent Removal and Follow-up**: Stents are usually removed a week after the procedure, and any remaining stones may be addressed in a staged follow-up surgery.
  • 📅 **Timing of Procedures**: Sometimes, due to complications like infection, the follow-up for stone removal and stent removal may be delayed for a few weeks to allow the kidney to heal.
Q & A

  • What is ureteroscopy?

    -Ureteroscopy is a common surgical procedure in urology used to treat small to medium-sized kidney and ureteral stones. It involves the use of a small scope, called a ureteroscope, which is inserted into the ureter to locate and treat the stones.

  • What are the main organs involved in the urinary system?

    -The main organs involved in the urinary system are the kidneys, which filter the blood and produce urine; the ureters, which are tubes that connect the kidneys to the bladder; and the bladder, which stores the urine until it is excreted.

  • What is the most common type of kidney stone?

    -The most common type of kidney stone is calcium oxalate, followed by uric acid stones, and then other types such as calcium phosphate and magnesium ammonium phosphate stones.

  • What are some symptoms of a kidney stone?

    -Symptoms of a kidney stone can include severe pain that radiates to the front, nausea, vomiting, fever, chills, blood in the urine, and sometimes the need to urinate urgently.

  • How are kidney stones typically diagnosed?

    -Kidney stones are typically diagnosed using two main methods: an ultrasound, which is safer, quicker, and less expensive, and a CT scan, which is considered the gold standard as it provides detailed information about the location, size, and potential blockage of the stones.

  • What is hydronephrosis and why is it significant?

    -Hydronephrosis refers to the dilation and accumulation of fluid in the kidney. It is significant because it indicates a blockage, often caused by a kidney stone, which can impair the kidney's function and requires medical attention.

  • What is the initial medical therapy for someone with a kidney stone?

    -Initial medical therapy for a kidney stone includes hydration, pain medication such as Toradol, Percocet, Tramadol, or Oxycodone, and a medication called Tamsulosin (Flomax) which helps relax the ureter to facilitate the passage of the stone.

  • What does the urologist do during ureteroscopy if a stone is found in the ureter?

    -If a stone is found in the ureter during ureteroscopy, the urologist may use a laser fiber to break the stone into smaller pieces, turning it into dust. These fragments can then be removed with a basket or allowed to be naturally expelled by the body.

  • Why are stents used after ureteroscopy?

    -Stents are used after ureteroscopy to ensure that the kidney is draining properly. Proper drainage is crucial for maintaining kidney health, even if the patient may experience some discomfort or side effects from the stent.

  • What are some side effects of having a stent in place?

    -Having a stent in place can cause urgency and frequency of urination, constipation, back pain (especially during urination), and blood in the urine. These side effects are typically managed with medication.

  • What happens if the ureter is too small for the ureteroscope to pass during the first surgery?

    -If the ureter is too small for the ureteroscope to pass during the first surgery, a stent may be placed to help dilate the ureter over several days. After this dilation, a second ureteroscopy, or 'second look', is performed to attempt the procedure again.

  • How is the removal of a stent typically scheduled after stone surgery?

    -The removal of a stent is typically scheduled a week after the stone surgery. However, if there are complications such as infection or if the patient has many stones, the removal may be postponed for a few weeks to allow the kidney to calm down and heal.

Outlines
00:00
🩺 Understanding Ureteroscopy and Kidney Stones

Dr. Mark Greenstein introduces the topic of ureteroscopy, a common urological procedure for treating kidney and ureteral stones. He explains the anatomy involved, including the kidney's role in filtering blood and creating urine, the ureter's function as the connecting tube to the bladder, and the bladder's role in storing urine. Kidney stones form when there's an imbalance of salts, minerals, and proteins in the urinary system, with calcium oxalate being the most common type. Symptoms can range from severe pain and nausea to blood in the urine. Diagnosis typically involves an ultrasound or a CT scan, with the latter being the gold standard for determining stone location and size. Treatment may start with medical therapy to attempt to pass the stone naturally, but if unsuccessful, surgical intervention using a ureteroscope is performed. The procedure involves inserting a small scope into the ureter to locate and break apart the stone with a laser, after which a stent may be placed to ensure proper kidney drainage.

05:00
🛠️ Surgical Challenges and Post-Procedure Care

The second paragraph discusses the challenges that can arise during ureteroscopy, particularly when dealing with very small ureters that cannot accommodate the surgical camera initially. In such cases, a stent is placed to help dilate the ureter over several days, allowing for a second attempt at the procedure. Dr. Greenstein uses the analogy of a square peg in a round hole to describe the difficulty of navigating the camera through a narrow ureter. Post-surgery, patients are given medication to manage pain, burning sensation, and potential infections. The stent, although uncomfortable and causing side effects like urgency, frequency, constipation, and back pain, is crucial for kidney health. After the stones are cleared, the stent is removed, and any leftover stones are addressed in a follow-up procedure. The summary emphasizes the importance of patience and medical intervention to ensure the best patient outcomes.

Mindmap
Keywords
💡Ureteroscopy
Ureteroscopy is a minimally invasive surgical procedure used to visualize and treat urinary stones, particularly those located in the ureter and kidney. In the context of the video, it is the standard of care for small to medium-sized kidney and ureteral stones. The procedure involves inserting a ureteroscope, a thin tube with a camera, into the urinary tract to locate and treat the stones.
💡Kidney Stones
Kidney stones are hard deposits made of minerals and salts that form inside the kidneys. They can cause severe pain as they move through the urinary tract. The video discusses the common types of kidney stones, such as calcium oxalate and uric acid stones, and their symptoms, which include pain, nausea, and blood in the urine.
💡Anatomy
The video script begins with an overview of the urinary system's anatomy, which includes the kidneys, ureters, and bladder. Understanding this anatomy is crucial for grasping how kidney stones form and how ureteroscopy is used to treat them. The kidneys filter blood and produce urine, the ureters transport urine to the bladder, and the bladder stores urine until it is excreted.
💡Hydronephrosis
Hydronephrosis refers to the swelling of the kidneys due to the buildup of urine. In the video, it is mentioned in the context of a blockage caused by a kidney stone. The term is significant as it indicates a condition that may require medical intervention, such as the insertion of a stent to ensure proper drainage and prevent further complications.
💡Ultrasound
Ultrasound is a non-invasive imaging technique used to visualize internal organs, including the urinary system. In the video, it is one of the two main diagnostic methods for kidney stones, alongside the CAT scan. Ultrasounds are preferred at Advanced Urology due to their safety, speed, and lower cost, although a CAT scan may be necessary for more complicated cases.
💡CAT Scan
A CAT (Computed Axial Tomography) scan is an imaging method that uses X-rays and computer processing to create detailed images of the body's internal structures. It is described in the video as the 'gold standard' for diagnosing kidney stones, as it provides precise information about the location, size, and potential blockage caused by the stones.
💡Medical Therapy
Medical therapy, as discussed in the video, is the initial treatment approach for kidney stones, particularly when hydronephrosis is present. It involves hydration, pain management, and the use of medications like tamsulosin (Flomax) to help relax the ureter and facilitate the passage of the stone.
💡Stent
A stent is a small, flexible tube that is inserted into the urinary tract to ensure proper drainage of the kidney. In the context of ureteroscopy, a stent may be placed after the procedure to prevent blockages and ensure the kidney continues to drain urine effectively. The video mentions that while stents are not the most comfortable, they are crucial for maintaining kidney health.
💡Laser Fiber
A laser fiber is a thin instrument that can be passed through a ureteroscope to fragment kidney stones into smaller pieces. The video describes the process as 'playing asteroids,' where the laser is used to break the stones into dust that can be more easily passed or removed. This technique is a key part of the ureteroscopy procedure.
💡Second Look Ureteroscopy
Second look ureteroscopy refers to a follow-up procedure performed after the initial ureteroscopy if the initial attempt to clear the stones was not fully successful. The video explains that in some cases, the ureter may be too small to allow the ureteroscope to pass through on the first try. After a stent is placed and the ureter dilates, a second procedure can be conducted to clear the remaining stones.
💡Ureteral Dilation
Ureteral dilation is the process of stretching the ureter to allow for easier passage of the ureteroscope and treatment of kidney stones. The video discusses how in some cases, the ureter may be too narrow for the procedure, necessitating the placement of a stent to induce dilation over several days before a second attempt at ureteroscopy can be made.
Highlights

Ureteroscopy is a common surgery for treating small to medium-sized kidney and ureteral stones.

The anatomy of the urinary system is crucial for understanding kidney stones, involving the kidney, ureter, and bladder.

Kidney stones form when there's an imbalance of salts, minerals, and proteins in the urinary system.

Calcium oxalate is the most common type of kidney stone, followed by uric acid stones.

Symptoms of a kidney stone include severe pain, potential fever, chills, and blood in urine.

Diagnosis of kidney stones is primarily done through ultrasound or CT scan, with CT being the gold standard.

Ultrasound is preferred at Advanced Urology due to its safety, speed, and cost-effectiveness.

Hydronephrosis indicates a blockage and water buildup in the kidney, requiring medical therapy.

Medical therapy for kidney stones includes hydration, pain medication, and a medication to relax the ureter.

If medical therapy fails, ureteroscopy is performed to physically break apart and remove the stones.

A ureteroscope is a tiny scope used to access and treat stones within the ureter and kidney.

Laser fiber technology is used to fragment stones into dust, which can then be naturally expelled by the body.

Stents are placed post-surgery to ensure the kidney drains properly and maintain kidney health.

Stents can cause discomfort such as urgency, frequency, constipation, back pain, and blood in urine.

In some cases, a second ureteroscopy may be necessary if the ureter is too small for the scope to pass through initially.

The ureter can stretch over time, allowing for a second attempt at ureteroscopy to be more successful.

Stent removal and any additional stone removal procedures are typically scheduled after the initial surgery.

Infections or complications may require a delay in the stent removal or further stone treatment.

Transcripts

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