Ureteroscopy for Upper Tract Tumours and Kidney Stones
A minimally invasive telescopic procedure to inspect the ureter and kidney from within — used to diagnose and treat upper tract urothelial cancer, and ureteric and kidney stones, and to assess the upper urinary tract. No external incisions are required.
Ureteroscopy involves passing a thin telescope (ureteroscope) through the urethra and bladder, and up into the ureter and kidney — following the body’s natural urinary passages, so no cuts are made in the skin. It is used both to treat stones in the ureter or kidney, and to investigate and treat abnormalities of the upper urinary tract lining, including upper tract urothelial cancer (UTUC).
For suspected upper tract urothelial cancer, ureteroscopy allows Dr Tan to directly inspect the lining of the ureter and kidney, take tissue samples (biopsy) and washings for laboratory analysis, and confirm the diagnosis. In selected cases, small tumours may be treated directly through the ureteroscope using laser ablation as part of a kidney-sparing approach. The findings help determine whether kidney-sparing treatment or more extensive surgery (such as nephroureterectomy) is most appropriate for your situation.
A rigid ureteroscope is typically used for stones in the lower ureter, while a flexible ureteroscope can be steered up into the kidney to reach stones in any position. Where a stone is found, a laser fibre is passed through the scope to fragment the stone into tiny pieces (laser lithotripsy), which are either removed with a small basket or left to pass naturally in the urine.
In many cases a temporary ureteric stent — a soft internal tube — is left in place afterwards to ensure the kidney drains freely while any swelling settles. This is usually removed a short time later in a brief follow-up procedure.
02
Before your procedure
A urine test is performed beforehand — any infection must be treated before the procedure, as operating in the presence of infection carries risk.
If upper tract urothelial cancer is suspected, prior imaging (such as a CT urogram) and any urine cytology results will be reviewed to plan the procedure.
Fast for six hours before surgery. You may usually drink water up to two hours prior, unless advised otherwise.
Inform Dr Tan’s team if you take blood-thinning medication — this may need to be paused before the procedure.
A prophylactic antibiotic is usually given at the time of the procedure to reduce the risk of infection.
Arrange for someone to drive you home, as you will have had a general anaesthetic.
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Risks and benefits
No incisions
The procedure is performed entirely through the body’s natural passages, so there are no cuts and no external scars.
Fragments the stone under direct vision
Laser fragmentation is an effective treatment for stones; clearance is often achieved in a single procedure, though more than one may sometimes be needed.
Quicker recovery
Most patients return home the same or next day and resume normal activities within a few days.
Common
Stent discomfort
If a ureteric stent is placed, it can cause urinary urgency, frequency, a sensation of incomplete emptying, or mild flank discomfort when passing urine. These symptoms resolve once the stent is removed.
Common
Blood in the urine
Light blood-staining of the urine for a few days afterwards is normal and settles with good hydration.
Uncommon
Urinary infection
Despite preventive antibiotics, some patients develop a urine infection requiring a course of antibiotics. Report fever, chills, or burning to the team.
Uncommon
Incomplete stone clearance
Occasionally not all stone fragments can be cleared in one sitting, and a further procedure may be required.
Uncommon
Inconclusive biopsy
For suspected upper tract cancer, biopsy samples taken through the ureteroscope are small, and occasionally a repeat procedure is needed to obtain a definitive diagnosis.
Rare
Need for further cancer surgery
Where upper tract urothelial cancer is confirmed, more extensive treatment such as nephroureterectomy may still be required. Dr Tan will discuss all options with you.
Rare
Ureteric injury
Injury or narrowing (stricture) of the ureter is rare. Very occasionally the procedure cannot be completed as planned and a stent is placed to allow treatment at a later date.
Rare
Sepsis
Serious infection of the urinary tract is uncommon but can be significant. It is minimised by treating infection beforehand and giving antibiotics at the time of surgery.
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Aftercare and recovery
1
Hydration
Drink plenty of fluids in the days after the procedure to help flush the urinary tract and pass any remaining stone fragments.
2
Stent removal
If a stent has been placed, a date will be arranged for its removal — usually a quick procedure, often under local anaesthetic in the clinic.
3
Return to activity
Most patients return to normal activities within a few days. Strenuous exercise can usually resume within a week.
4
Stone analysis and prevention
Where possible, stone fragments are sent for analysis to guide advice on preventing future stones. A metabolic assessment may be recommended for recurrent stone formers.
5
Cancer surveillance and follow-up
If upper tract urothelial cancer is being investigated or treated, ongoing surveillance with repeat ureteroscopy and imaging is arranged. Dr Tan will discuss biopsy results and the recommended plan at your follow-up.
Will I need a stent, and if so, how long will it stay in?
Is ureteroscopy the best option for my stone’s size and location?
If cancer is suspected, will I have a biopsy during the procedure, and when will results be available?
If upper tract cancer is confirmed, what are my options — kidney-sparing treatment versus nephroureterectomy?
What surveillance or follow-up will I need afterwards?
What is the chance I will need more than one procedure?
Will my stone be sent for analysis?
What can I do to prevent stones forming again?
What symptoms should prompt me to seek urgent advice?
Disclaimer
This information is for general education and is not a substitute for personal medical advice.
Content adapted from the British Association of Urological Surgeons (BAUS) and the American Urological Association (AUA) patient information resources.
Investigating upper tract cancer, or dealing with stones?