Laser of Ureteric or Renal Stone

WHAT IS LASER OF STONE?

During your consultation with Dr Vasudevan a diagnosis of a stone being present in either your ureter (tube that joins your kidney to your bladder) or the urine collecting system in your kidney will have been made.

Dr Vasudevan, will have recommended that the stone be removed by fragmenting the stone into tiny pieces or dust using a laser machine.

The most common laser that is used for this purpose is a holmium laser.

WHAT ARE THE INDICATIONS FOR LASER OF STONE?

The reasons for laser fragmenting a stone are:

  • Stone that is trapped in the ureter and is not passing out by itself or is causing severe pain.
  • Stone in the collecting system of the kidney causing pain, infection or blood in the urine.

WHAT DOES LASER STONE PROCEDURE INVOLVE?

Lasering of stone, will be done under a general anesthetic as a day procedure or in some cases will need an overnight stay in hospital.

You will be asked to fast for 6 hours prior to the procedure. Once you arrive at the hospital the nursing staff will admit you and get you prepared for the procedure.

You will be taken to the operating room once your turn has arrived.

The anesthetist will give you medications to make you sleep completely. Once you are asleep, Dr vasudevan will clean the required area with an anti-septic solution such as betadine. A cystoscope will be inserted via the urethra and into the bladder. The bladder will be inspected to check that it is normal in appearance. Once this is completed x-ray dye will be injected into the ureter and kidney to locate the position of the stone. Following this, an instrument called an ureteroscope is inserted into the ureter and kidney to visualize the stone. Once the stone is seen the laser fiber is passed through the ureteroscope to commence fragmentation of the stone which is under constant vision while being fragmented. Once the stone has been fully fragmented a JJ stent will be inserted to facilitate passage of the tiny stone fragments. Once the procedure has been completed you will be woken up and taken to the recovery area where you will be kept under observation till you are fully awake. Dr Vasudevan will review you once you are fully awake and will advise you if you can be discharged the same day or will need to spend a night in hospital.

WHAT CAN YOU EXPECT AFTER THE PROCEDURE?

The following are common things that can be expected on completion of the procedure:

  • Blood in the urine- This very common and is mainly due to the presence of the stent in the ureter and kidney rubbing the inner lining of the ureter and kidney causing the appearance of blood in the urine.
  • Discomfort in the back – This is especially so when passing urine and is also due the presence of the stent causing urine to reflux up into the kidney.
  • Constant feeling of wanting to pass urine – due to the stent in the bladder irritating the inner lining of the bladder.

WHAT ARE THE POSSIBLE COMPLIACTIONS WITH LASER OF STONE?

While majority of laser stone procedures are very routine, possible complications that can occur include;

  • Inability to access or reach the stone and hence not being able visualize the stone to laser fragment it. This happens in about 5 to 10% of patients. If this were to happen a JJ stent will be inserted and the patient will be brought back a few weeks later to re-attempt laser of stone. The stent during this time will have dilated the ureter adequately to reach the stone at the second attempt.
  • Infection – can happen in 1% to 2% of patients. Dr Vasudevan will test your urine 10 days prior to surgery to minimize the risk of infection. If infection is present prior to surgery antibiotics will be given to rid the urine of infection so that the procedure can proceed safely. Antibiotics are also given during surgery to reduce the risk of infection. If despite all these precautions you are having temperatures or feeling unwell after completion of surgery you will be kept in hospital and given antibiotics till it is fully resolved.
  • Minor damage to wall of the ureter – this happens in 1% of patients. It is not of any concern and will heal by itself with the assistance of the JJ stent.
  • Stricture of ureter – This is a narrowing of the ureter due to scar formation. This may happen in 0.5% to 1% of patients. If this happens a JJ stent will be needed and rarely further surgery may be needed to fully rectify the stricture.
  • Major injury to the ureter – This is extremely rare and may occur in less than 0.1% of patients. If this happens further surgery will be needed to fully rectify the situation.

FOLLOW-UP WITH DR VASUDEVAN

If a stent has been inserted Dr Vasudevan will arrange a date for 2 weeks after the surgery to have the stent removed.

Stent removal is a very simple procedure and is done under a local anesthetic as a day procedure.

In some cases Dr Vasudevan may want to perform a follow-up CT scan to ensure that all the stones have been removed. Dr Vasudevan will advise you if this is required.