As the trend in medicine continues toward minimally invasive surgical procedures, there has been a steady increase in the number of ureteroscopic procedures performed. Applied Medical provides a variety of high quality, innovative products to simplify these procedures. The procedure is performed using a thin endoscope (ureteroscope) introduced through the urethra to view and treat the bladder, ureters and kidneys.

What are kidney stones?
Kidney stones are crystal-like structures formed in various parts of the urinary tract. Most often stones start small and gradually grow larger. Stones typically form in the kidney, where they may remain without symptoms and do not require treatment. Sometimes stones break loose and try to pass on their own with the normal flow of urine. However, when a stone enlarges or moves, it can cause obstruction and severe pain requiring intervention.

There are various types of urinary tract stones. Stones may be hereditary, caused by high acidity in the urine, or caused by infection and may harbor bacteria. The Urologist will need to determine the size and composition of the stone in order to choose the appropriate treatment method.

Ureteroscopic Stone Removal
If the stone cannot pass on its own, the doctor may remove it without making an incision. A ureteroscope is inserted through the urethra to the stone site. Next, a wire basket or grasping forceps is advanced through the ureteroscope and used to trap the stone within its wires. Once the stone is trapped within the wires, it is withdrawn as a unit with the ureteroscope. Finally, a stent, a small tube used to facilitate drainage and healing, is placed over the guidewire and typically left in place for a minimum of 24 hours.

Other Medical Treatments:

Extracorporeal Shock Wave Lithotripsy
This is a non-invasive method of breaking up kidney stones. Kidney stone centers and mobile units, as well as some hospitals, utilize this method for some of their stone removal procedures.

The Procedure:
• The patient lies down on a water cushion or sits in a water bath.
• A rapid series of high-energy shock waves is aimed directly at the stone site and passes through the body shattering the stone into very fine sand.
• The patient is then stented to aid the drainage and passage of the stone fragments.

Open Surgery
With the advent of less invasive procedures, only patients with stone that are unusually large, oddly shaped or in difficult to reach locations need open surgery.

The Procedure:
• An incision is made in the patient's side.
• The kidney or ureter is opened and the stone is removed.
• A tube is placed at the incision site to drain the urine.

Percutaneous Stone Removal
Percutaneous lithotripsy is more invasive than ureteroscopy. It is used mainly to remove difficult large kidney stones.

The Procedure:
• A small incision is made in the back of the patient through which a nephroscope is introduced and a fragmentation device is inserted into the working channel of the nephroscope.
• Similar to ureteroscopic methods, several passes may be necessary to fragment and remove the stone. Stones are typically fragmented by ultrasound and the stone particles are suctioned out of the kidney.
• After the procedure a drainage tube is left in place for a few days to drain urine from the kidney.