Thyer Urology

The ureter is the tube that transports urine from the kidney in the upper abdomen to the bladder in the pelvis. Ureteroscopy is a procedure where a thin scope is passed through the ureter via the bladder to directly inspect the internal aspect of the ureter. This is most commonly performed for urinary stone disease but may also be performed where there is unexplained bleeding, a tumour is suspected based on imaging or there is a blockage that needs further investigation.

Pre operation

Ten days prior to the procedure you should have your blood and urine test. Notify Mr Thyer’s rooms if you are:

• Taking any blood thinning medication
• Female and under the age of 50 (a pregnancy check is required before this procedure as X-rays are used)
• Allergic to iodine or any radiologic contrast

The procedure

On arrival at hospital you will be prepared for theatre by nursing staff. Mr Thyer will see you just prior to being taken into the operating theatre. You will require a general anaesthetic of approximately 30 minutes to 1 hour. Mr Thyer will introduce a thin ureteroscope into your ureter via the urethra and bladder. No skin incision is required. Stones will be broken up with laser and usually also removed if safe to do so. Tumours will be biopsied and occasionally also burnt to prevent recurrence if small and superficial. If biopsies or stone specimens are taken these will be sent to a pathologist for examination (you may incur a pathologist fee). A ureteric stent will usually be placed. Following the procedure, the ward nurse will check you have passed urine then you will be sent home usually the same day but an overnight stay is occasionally required.

Risks

• Bleeding. Blood blood in the urine usually lasts until the stent is removed.
• Infection. This occurs in less than 5%.
• Urinary retention. Rarely you may not be able to pass urine after the procedure and you may be discharged with a catheter to be removed after one week.
• Bladder irritation. It is normal to have urgency and frequency of urination.
• Stent discomfort. This is pain felt in the flank after ureteroscopy. Rest, Panadol, Nurofen and Ural can all be of assistance and can be purchased from the Pharmacist.
• Failed ureteric access. In about 10% of cases the ureter can be too tight for the scope to pass to the desired position. In this situation Mr Thyer will place a ureteric stent for 1-2 weeks allows the ureter to dilate slowly then bring you back to theatre to re-attempt ureteroscopy.
• Ureteric injury. Very rarely the ureter can be injured with the ureteroscope. This can usually be managed with placement of a stent for 4-6 weeks. Very rarely an open operation may be required to repair the damaged ureter.
• Retained fragments of stone. Some stone fragments may not pass despite being lasered into very small fragments. Occaionally, a repeat ureteroscopy may be required to ensure complete clearance.
• There are risks with any general anaesthetic which are very rare including blood clots, heart or lung problems and adverse drug reactions. The anaesthetist will discuss these with you at the time of the procedure.

Follow up

You should take laxatives, drink plenty of water and avoid heavy lifting for 3 weeks following the procedure. If a biopsy was taken, you will have an appointment made with Mr Thyer in his rooms to check on your pathology at 2-3 weeks. If a stent was placed this is usually removed with a flexible cystoscope under local anaesthetic after 1-2 weeks but this time may vary depending on availability of flexible cystoscopy.

When to contact Mr Thyer

Following the procedure, you should contact Mr Thyer if you:

• Have a fever over 38 Degrees
• Are unable to pass urine
• Have large clots in the urine
• Have not received a follow up appointment
• You can contact Mr Thyer via his rooms during working hours or after hours via the after hours nurse at Hollywood Hospital on (08) 9346 6000
• You can attend the emergency department at the hospital at which you had your procedure. (Hollywood Private Emergency Department charge a fee for attendance).