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<h1>Endourology</h1>
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<h4>What is Endourology?</h4>
<p>Endourology is a minimally invasive technique available to
treat kidney stones. Stones may be extracted or fragmented
using tiny instruments through natural body channels such as the
urethra, bladder and ureter. Thin, flexible instruments
including lasers, graspers, miniature stone retrieval baskets,
special scalpels, and cautery, can be advanced through working
channels in the scopes in order to perform surgery without creating
any incisions at all. The majority of endoscopic procedures can be
done on an outpatient basis.<br>
Endourological procedures include:
</p><ul type="disc">
<li>Urethroscopy: used to treat strictures or blockages of the urethra. </li>
<li>Cystoscopy: used to treat bladder stones and
tumors. Obstructing prostate tissue can be removed with this approach
as well (a procedure called "TURP"). Flexible plastic tubes called
stents can be passed up the ureter using cystoscopy and x-rays to
relieve blockage of the ureter. </li>
<li>Ureteroscopy: used to treat stones and tumors of the ureter. </li>
<li>Nephroscopy: used to treat stones and tumors of the kidney lining. <strong><br>
</strong> </li>
</ul>
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<h4>Q. What types of Endoscopic procedures are there?</h4>
<p><strong>Extracorporeal Shock Wave Lithotripsy</strong><br>
This minimally invasive technique for the disintegration of stones
involves the administration of shock waves that are generated by a
machine called a lithotriptor. After the machine is calibrated, and the
stone has been targeted, shock waves are focused and passed through
the body in such a manner that their maximum energy is dispersed at
the locale of the stone, with the intent of stone disintegration. The
pulverized fragments then pass in the patient�s urine. The procedure
works best for smaller stones. Other determinants for success with
this treatment technique include stone composition and the specific
anatomic location of the stone within the urinary tract. <br>
<br>
</p>
<p><strong>Ureteroscopy</strong><br>
The ureters are narrow conduits (tubes) that carry urine from the
kidney down to the bladder. They are normally quite small in caliber,
but may become dilated (wider) when they are obstructed.
Ureteroscopes are precision instruments used for surgical procedures
within these structures. At times an ureteroscope may also be used to
traverse the length of the ureter in order to perform a procedure in
the kidney.<br>
<br>
</p>
<p><strong>Ureteroscopic treatment of stones</strong><br>
In certain cases, ureteroscopy is the most effective treatment for
urinary stones. The following are specific situations where
ureteroscopy is the treatment of choice:</p>
<ul>
<li>Where stones have not been completely broken up and cannot
passed through the urine after treatment with extracorporeal shock
wave lithotripsy; </li>
<li>When stones are lodged in the portion of the ureter near the
bladder, a region where a shock wave lithotriptor may have difficulty
focusing shock waves for breakage of the stone; </li>
<li>When there are stones in particular parts of the kidney (the
lower portion) that even if broken up by extracorporeal shock wave
lithotripsy, cannot, due to contour and angulation, pass out of the
kidney;<br>
Where stones are associated with other unusual ureteral/kidney anatomy. </li>
</ul>
<p>Various devices can be placed through the ureteroscope to facilitate
stone breakage and removal. These include lasers, miniature
jackhammer like stone impactors, and other similar tools that cause
stones to fragment when these devices are activated. Miniature baskets
can also be placed for removal of stone fragments.<br>
The narrow ureter oftentimes swells in reaction to stone treatment,
and as such, a stent, a tube resembling a thin drinking straw with
curls on each end, is placed in the ureter for a few days until this
swelling subsides. This stent is easily removed in the outpatient
clinic shortly after the procedure.<br>
<br>
</p>
<p><strong>Ureteroscopic treatment of ureteral/renal strictures and other renal disorders</strong><br>
Due to a variety of causes, including stones that remained impacted
in the ureter for a long time, the ureter may stricture; that is to
say, scar and narrow to a point where urine cannot readily pass. In
these situations, the obstruction of urinary flow often results in
pain. However; if obstruction is slow in onset, the patient may not
notice pain specifically related to the kidney. The obstruction of
urinary flow, if not relieved, will eventually result in kidney
damage. These obstructions must be treated. Strictures of short
length and duration can be cut open with a laser or other device
placed through a ureteroscope. A stent is then placed while the ureter
heals. Strictures that are longstanding and of longer length and
complexity may require repeat procedures, or a more complex
procedure, such as laparoscopy or open surgery, for correction.<br>
<br>
</p>
<p><strong>Percutaneous Renal Surgery</strong><br>
Percutaneous renal surgery involves the placement of catheters through
the skin in the patient�s back into the drainage system of the
kidney. Subsequently this passageway can be dilated to facilitate the
placement of working tubes and instruments to break up/remove stones
and to perform other necessary procedures (including relief of
kidney obstruction). Though more invasive than extracorporeal
shockwave lithotripsy and ureteroscopy, this procedure offers
substantial benefits in terms of patient recovery when compared to
open surgical procedures that, in the past, often had to be performed
to treat large kidney stones or other significant kidney diseases.<br>
</p>
<p><strong>Percutaneous Removal of Stones</strong><br>
Large kidney stones often cannot be effectively treated by
extracorporeal shock wave lithotripsy or ureteroscopy. Though these
procedures can be attempted, their limitations may become evident.
Extracorporeal shock wave lithotripsy can be performed, but it can be
difficult to break a large stone in its entirety by this means.
Furthermore the fragments that are broken must all pass, which may
cause significant discomfort for the patient for a prolonged period of
time. It then becomes necessary for more procedures, which require
anesthesia, to be performed to remove the residual stone. Ureteroscopy
can also be performed, but because the ureteroscope and the ureter
are of small caliber, it may be difficult to break a large stone by
this means, and then remove all of the fragments. Once again, a
greater number of procedures, which require anesthesia, may need to
be performed.<br>
<br>
Due to these limitations percutaneous removal of large kidney
stones is often necessary. Through a tube passed directly into the
kidney, larger instruments and devices can be placed directly into the
kidney for stone breakage and removal. Even large stones can be
removed in one procedure. For very large stones, a �second look�
procedure, to clear residual stone fragments, is often necessary. Due
to the nature of this procedure, which involves placement of
surgical instruments through the kidney itself, a small chance of
transfusion exists. Most patients stay in the hospital overnight
after this procedure. <br>
</p>
<p><strong>Percutaneous treatment of renal obstruction</strong><br>
Kidney obstruction may occur due to problems such as scarring or
stricturing of the ureter. Many of these obstructive processes can be
managed with ureteroscopy or percutaneous surgery. The nature and
complexity of the obstruction often dictate which of these methods will
be necessary. For less complex obstructions, the less invasive
ureteroscopic means can possibly be used, but for more complex
obstructions, which are usually related to specific aspects of the
anatomy of the kidney, the percutaneous method may be necessary. <br>
</p>
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