Ureteroscopy with laser lithotripsy (ULL) is a medical procedure that breaks up kidney stones lodged in a ureter. Ureters are the tubes that connect your kidneys and bladder.
Kidney stones affect about 1 in 10 people in the United States, and their prevalence has risen. Doctors use many interventions to treat the condition. ULL combines two procedures:
- Ureteroscopy: A doctor uses a special instrument — a ureteroscope — to locate a stone inside your ureter.
- Laser lithotripsy (LL): Lithotripsy breaks kidney stones into tiny pieces. This specific type uses a laser.
Keep reading to learn about ULL — the procedure, its risks, side effects, alternatives, and other information.
Not everyone needs a ULL. Your doctor may suggest other
- medications
- ureteroscopy without lithotripsy
- ureteroscopy with other types of lithotripsy, for example, shock wave lithotripsy (SWL)
- surgery
Ureteroscopies are safer than surgeries. They are often a preferred choice of treatment for kidney stones.
Doctors usually use SWL for stones inside your kidneys when choosing which type of lithotripsy to use. You may be a candidate for LL if your kidney stones are lodged inside your ureter, especially if they are close to the bladder.
LL might be more effective than SWL because it uses the energy of a laser beam that directly hits the stone.
ULL is usually an outpatient procedure, so you don’t need to stay in the hospital.
Before the procedure, your doctor will run tests to determine the number of stones and their size and location. They will likely order a CT scan or an X-ray.
Be sure to let your doctor know whether you’re taking any medications. You may need to stop taking certain medications before and during a ULL. This includes blood thinners and certain over-the-counter (OTC) pain relievers, such as aspirin or ibuprofen. This is because they can cause excessive bleeding during the procedure.
During a ULL, you will be under general anesthesia. Because of this, you may need to fast for 8 to 12 hours before the procedure.
Once you are asleep, your surgeon will pass a ureteroscope (a thin, flexible tube with a camera) through your urethra and bladder and into the ureter until it reaches the stone. They will then use a laser to break up the stone.
After the doctor has broken the stone into tiny pieces, they can remove it from the ureter. In most cases, a surgeon will also place a stent to ensure that the kidney properly drains urine after the procedure. They’ll remove the stent a few days after the procedure.
Recovery
After the procedure, you will move to a recovery room. Once your pain is under control and you can urinate, the medical staff may discharge you.
Anesthetics can cause drowsiness and nausea for several hours after the procedure. Be sure to have someone available to drive you home.
After the procedure, you may experience pain in your bladder area. Your doctor may prescribe you oral narcotics such as Percocet or Vicodin. Later on, you may be able to switch to Tylenol or ibuprofen.
You may see blood in your urine after the procedure. This is typical and should go away with time.
Follow-up
You will have a follow-up appointment a few days after your ULL to remove the stent. You may have additional appointments as well. Be sure to ask your doctor about this.
You may experience the following side effects after a ULL:
The main risk of ULL is infection. To prevent it, your doctor will likely give you antibiotics before sending you home.
You should monitor your body temperature. A fever can indicate infection. Be sure to contact your doctor immediately if you develop a fever or chills in the days following the procedure.
Severe bleeding after a ULL is not common.
The following types of lithotripsy are the most common alternatives to LL:
- Extracorporeal shock wave lithotripsy (ESWL): This is the most common type of lithotripsy. It uses sound waves.
- Pneumatic lithotripsy: This method breaks up the stones using high-pressure fluids.
- Ultrasonic lithotripsy: This uses ultrasound to break up the stones.
- Electrohydraulic lithotripsy: An electrical shock breaks up the stones.
Your doctor will help you choose the best treatment based on:
- the location of the stones
- the size of the stones
- your general health
- your personal preference
ULL combines ureteroscopy with laser lithotripsy to locate and remove kidney stones lodged in your ureter. It is a minimally invasive procedure that requires general anesthesia. It’s usually safer and more effective than surgery.
There are few risks or side effects of ULL, but it can cause an infection.
Although ULL is safe and usually works, there’s still a chance your kidney stones could return. This would require more treatment. Staying hydrated can prevent kidney stones.