Pyeloscopy
What is pyeloscopy?
Pyeloscopy is a minimally invasive procedure used to examine the renal pelvis, which is the urine-collecting system within the kidney, and to treat stones or other abnormalities. A thin, flexible telescope called a ureteroscope is passed through the urethra, bladder and ureter into the kidney. Pyeloscopy is most commonly performed for the diagnosis and treatment of kidney stones, particularly when stones are too large, too hard or poorly positioned to pass on their own.
Why is it needed?
Pyeloscopy may be recommended when kidney stones are unsuitable for natural passage or when stones remain after previous treatments such as shock wave lithotripsy or ureteroscopy. It may also be required when there is a suspected blockage or narrowing within the kidney that needs further investigation.
The procedure can be used to inspect abnormalities of the renal pelvis, such as strictures or small tumours, and to take biopsies when necessary. It provides detailed visual assessment and allows direct treatment during the same procedure.
What happens during the procedure?
Pyeloscopy is performed under general anaesthesia. A flexible ureteroscope is gently inserted through the urethra, bladder and ureter into the kidney. Stones may be treated using laser lithotripsy to break them into smaller pieces, or fragments may be removed directly using specialised retrieval devices.
A ureteric stent, which is a small internal tube, is often placed to help urine flow and protect the ureter while it heals. A bladder catheter may also be left in place temporarily. The procedure usually takes between sixty and one hundred and twenty minutes depending on the number and size of the stones. Most patients go home the same day or after an overnight stay.
What are the alternatives?
Several alternative treatments may be considered depending on the size, type and location of the stones. Extracorporeal shock wave lithotripsy is a non-invasive option that uses sound waves to break stones from outside the body. Percutaneous nephrolithotomy is a keyhole surgical procedure used for larger or more complex kidney stones.
Observation and medication may be suitable for smaller stones likely to pass naturally. In some medically complex cases, long-term stenting may be considered when surgery is not appropriate.
Potential risks and after effects
Pyeloscopy is generally safe, but some temporary effects are common. Mild pain or burning on urination may occur for several days. Blood in the urine is relatively common initially and usually clears quickly.
Urinary tract infection may occur and may require antibiotics. Rarely, injury to the ureter or kidney can occur and may require a stent or further treatment. Long-term scarring and narrowing of the ureter, known as a ureteric stricture, may develop in a small percentage of patients.
Stent-related symptoms such as urinary frequency, urgency or flank discomfort are common while the stent remains in place. In some cases, residual stone fragments may remain and require additional treatment.
After the procedure
Following pyeloscopy, mild discomfort, urinary frequency or urgency are common for a few days. Drinking plenty of fluids helps flush out stone fragments. Pain relief may be taken as needed.
Heavy lifting and strenuous activity should be avoided for approximately one week. If a ureteric stent has been placed, some awareness of urinary symptoms is normal until the stent is removed, which usually occurs within one to four weeks.
Follow-up care
A follow-up review is typically arranged within four to six weeks to check progress, remove the stent if present and assess the results of treatment. Imaging such as X-ray, ultrasound or CT scanning may be used to confirm stone clearance.
If residual fragments remain, additional treatment may be required. Long-term prevention strategies, including increased fluid intake and dietary adjustments, are recommended for individuals prone to recurrent stone formation.
Kidney & Stones Procedures
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