Introduction
Ureteroscopy and shockwave lithotripsy are generally used as a treatment of choice for the removal of urethral stones. However, impacted stones, stones more than one centimeter in diameter, cannot be removed by these procedures. Therefore to remove the ureteral stones, a procedure called ureterolithotomy is done.
What Is Ureterolithotomy?
Ureterolithotomy is a surgical procedure used to remove stones that are impacted in the ureter. The surgery can be done by laparoscopy or open surgery. Open surgery increases the length of the hospital stay and requires additional analgesic treatment. Therefore, laparoscopic treatment is used as an alternative management method. Yet the success rate of laparoscopic surgery is similar to that of open surgery. It is considered superior to open surgery as there is less requirement for analgesic treatment, speedy recovery, reduced hospital stay, and cosmetic outcome.
What Are the Pre-operative Requirements for Undergoing Ureterolithotomy Surgery?
The preoperative diagnosis for the surgery includes a detailed case history, urine culture, complete blood count analysis, urine, biochemical analysis of serum, intravenous pyelogram, computed tomography, and coagulation tests. Positive urine culture treated with antibiotics before the surgery. Urinary drainage is performed either by a catheter or a nephrostomy tube in patients with symptoms of acute renal failure, severe hydronephrosis, sepsis, and severe pain in the pre-operative period. Prior to the surgery, general anesthesia will be given for a painless procedure.
How Is Ureterolithotomy Surgery Performed?
The preferred approach for laparoscopic technique is retroperitoneal, whereas, in patients with a history of open retroperitoneal surgery or nephrostomy tube, a transperitoneal approach is preferred. In case of the stones present in the proximal ureter crossing the iliac vessels, the preferred approaches are intraperitoneal or midline extraperitoneal. And for stones present in the distal ureter, an extraperitoneal via a low midline approach is preferred.
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The patient is placed in a classical flank position with the twelfth rib directly over the kidney lift. The patient is positioned with broad tape extending from the hip region.
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The incision is made on the side of the abdomen. The incision location depends on the proximity of the stone. Both the skin as well as muscles are cut in order to expose the ureter. An incision is made in the ureter just above the stone.
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A stent can be placed in the ureter, which helps to keep the incision open. The stone is then removed.
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After the removal of stones, the ureter is then stitched. The muscle and the skin above are also stitched. A tube is then placed in the wound to drain out extra fluids while the wound heals.
What Is the Post-surgical Care Required After a Ureterolithotomy?
Immediately after the procedure, the patient is sent to An observation room. X-rays may be taken to make sure the stone has been completely removed. The entire surgery can take place between 60 to 90 minutes. Anesthesia prevents pain during and after the surgery and a hospital stay is required for three to four days; if the patient has any other problems, then they may require a little longer hospital stay.
Post-procedure care includes taking care of the incision and the drainage tube pleased to drain the extra fluid. A tube near the incision is placed to remove the extra fluid from the wound and is generally withdrawn after three to four days of surgery. An intravenous (IV) unit may be placed to provide nutrition during the hospital stay. A catheter is placed in order to drain the urine until the patient moves around on their own. The patient is encouraged to exercise and walk daily after the hospital stay. A blood thinning medication can also be given in order to prevent clots. After the hospital stay, it can take four to six weeks to recover from the procedure. The patient needs to follow the physician‘s instructions and restrictions as well.
When to Seek Medical Help?
Medical help must be taken in the following cases:
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Post-surgery complications like excessive bleeding.
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Bruising.
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Swelling or redness at the site of the incision.
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Extreme urge and inability to urinate.
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First training from the site of the incision.
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Signs of infection such as fever and chills.
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Pain that cannot be controlled with medications given.
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Persistent vomiting or nausea.
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Shortness of breath, chest pain, or cough.
What Are the Possible Complications of the Ureterolithotomy Surgery?
The possible complications of the ureterolithotomy surgery are:
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Bleeding could arise and may need a return to the operating room. Bleeding is more common if the patient has been taking blood-thinning drugs such as Aspirin, Warfarin, Clopidogrel, or Dipyridamole.
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Infection can occur, which is treated by antibiotics and further treatment.
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Small spaces of the lung can collapse, increasing the risk of chest infection. This can need antibiotics and physiotherapy.
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The increased danger in obese people of wound infection, heart and lung complications, chest infection, and thrombosis.
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A blood clot in the leg causes pain and swelling. In rare patients, part of the clot may break off and go to the lungs.
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A heart attack or stroke could happen due to the strain on the heart.
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Death as a consequence of this procedure is possible.
Specific Risks:
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A narrowing of the tube may generate at the site where the stone was removed. This may cause damage to the kidney.
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Leakage of urine can develop from the cut in the ureter. This can leak onto the skin's surface and may continue for some time.
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The stone or part of it may be lost and may move down to the bladder or back to the kidney. The stone or piece of it may not be able to be removed.
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Deep bleeding in the abdominal cavity can need fluid replacement or further surgery.
Conclusion
The ureter is a tube that drains urine from the kidneys to the bladder, and the ureterolithotomy is the procedure of removal of the stone from the ureter. This procedure requires anesthesia for a painless surgical procedure. It is generally performed in patients with impacted stones in the ureter. The associated risk factors include infection, bleeding from the wound, scarring, leakage of the urine, heart attack, blood clots, and death. Post-operative care includes taking care of the catheter and the tube around the incision to drain the excess fluid from the wound area. Post-surgical recovery occurs within four to six weeks after the hospital stay.
