Ureteroscopy

A ureteroscopy is a procedure that uses a thin telescope with a camera on the end to look inside your ureters and kidneys. 

Your doctor might also take a small piece of tissue (biopsy) from the ureter or kidney to check for cancer.

You normally have a ureteroscopy under general anaesthetic . And can usually go home later the same day or the day after.

Why you might have a ureteroscopy

A ureteroscopy helps find out the cause of symptoms such as blood or abnormal cells in your urine, or pain.

You may have this procedure if you’ve had a CT or MRI scan, but it isn’t clear what is causing your symptoms. Some people may have had a scan for something else and an abnormal area in the kidney or ureter has been picked up.

A ureteroscopy is one of the tests you might have to help diagnose upper urinary tract urothelial cancer. But it’s also used to diagnose non cancerous (benign) kidney and ureter problems.

Preparing for a ureteroscopy

You usually have a pre assessment appointment before a ureteroscopy. This is to make sure you're well enough for the general anaesthetic, and so you to know what to expect.

At your appointment the pre assessment team will:

• take your weight, blood pressure, pulse and temperature
• ask you questions about your health
• tell you if you need to stop taking any medicines before the procedure
• tell you when to stop eating and drinking before the procedure
• give you the chance to ask questions

They may ask you to have other tests such as blood tests or an electrocardiogram (ECG). These depend on your symptoms and general health.

What happens on the day?

You’ll meet the doctor who will be doing the procedure. They'll explain what’s going to happen and ask you to sign a consent form. You’ll also meet the anaesthetist who will give you the anaesthetic.

The ward nurses make sure you're ready for the procedure. They'll ask you to get changed into a hospital gown and you’ll go with them to the theatre.

Sometimes you might have a spinal anaesthetic instead of a general anaesthetic. This is where the anaesthetist injects local anaesthetic into the fluid around your spinal cord. It causes numbness in the lower part of your body so you can’t feel the procedure. You’re normally awake during the procedure if you have a spinal anaesthetic. Or you might have some medicine to make you feel sleepy (sedation).

You usually have a small tube put into your vein (cannula) before you have an anaesthetic. Your doctor and anaesthetist may use this to give you:

• anaesthetic medicines
• antibiotics

During a ureteroscopy

You lay on your back with your legs supported in 2 leg rests.

Your doctor passes a special telescope (cystoscope) up your urethra and into your bladder. They look at your bladder to see if there are any abnormal areas.

Then they pass a very thin wire through the cystoscope, up your ureter, to your kidney. They check that the wire is in the right place with x-rays and a special dye that helps them see the kidney better. Your doctor leaves the wire in place and removes the cystoscope.

They put a different telescope called a ureteroscope over the wire. As the ureteroscope goes up over the wire they can look at your ureter and kidney.

If any part of the ureter or kidney looks abnormal, they'll take a small piece of tissue (biopsy). They send this to the laboratory. A specialist doctor (pathologist) looks at it under a microscope to see if it is cancer.

Your doctor may leave a special tube inside your ureter called a stent. This stops your ureter from getting blocked after the procedure. It means urine can still flow from your kidney to your bladder.

After a ureteroscopy

You go back to the recovery room while the anaesthetic wears off. A nurse looks after you until you're well enough to go back to the ward.

Back on the ward, your nurse will encourage you to eat and drink as soon as you feel able to. In the first couple of days, you should try and drink double what you normally do. This helps stop you from getting an infection.

Your nurse lets you know when you can get up. They can help you get dressed if you need it. They will encourage you to move about the ward.

Your nurse will also ask you to collect your pee after a ureteroscopy. This is to make sure you are peeing enough and there’s not too much blood in it.  

You can normally go home later the same day or the next. If you're going home the same day, you'll need an adult with you for 24 hours afterwards. This is because of the anaesthetic.

Before you leave the hospital, your nurse will remove the cannula and give you any prescription medicines you need at home. They will also tell you:

• when to expect your follow up appointment
• when you can go back to normal activities

If you have a stent, you will have an appointment to have it removed a few weeks later. It is important the stent does not stay in too long. So contact your doctor if you haven’t heard anything after a couple of weeks.

Possible risks

As with any medical procedure there are possible side effects or complications. Your doctor makes sure the benefit of having the procedure outweighs these risks.

Possible complications include:

• a mild burning feeling when you pee
• blood in your pee
• a urine infection

Rarely your ureter may get damaged. This may mean you need an operation, or a tube put through your back into your kidney. This is called a nephrostomy . If you have a nephrostomy your nurse will show you how to look after it at home. 

If your surgeon has left a stent in your ureter this can irritate your bladder. You may:

• need to pee more often
• feel you need to pee urgently
• have pain in your side where the stent is

Your doctor or nurse will tell you what problems to look out for, and who to contact when you go home.

Getting your results

You should get your results within 1 or 2 weeks at a follow up appointment.

Waiting for results can be an anxious time. You might find it useful to talk to someone close to you.

Cancer Research UK nurses