The procedure is performed to remove large stones from ureter. Ureteric stones or calculi are found in 10% of the world’s population, making them fairly common. They occur when kidney stones move into the ureter, which connects the kidney to the bladder. Ureteric stones can cause acute and severe pain. Small stones will leave the body through urine, but larger ones can cause swelling of the kidneys (hydronephrosis). If untreated, the kidney may be lost.
 
Risk Factors for Developing Ureteric Stones

• Genetics.
• Not drinking enough water.
• Chronic urinary tract infections.
• Eating foods that contain substances that cause particles to form in the urine in large amounts.

1. A physical examination will be performed along with X-ray and ultrasound if needed.
2. Certain medications especially anticoagulants and blood thinners like aspirin may have to be discontinued at least 1 week before surgery. The patient should inform the doctor of all medications, supplements, and herbal supplements they are regularly taking.
3. If you have a urinary tract infection, the doctor may treat the infection with antibiotics before performing the procedure.
4. You will have to avoid all food and water for 6-8 hours before the procedure or as recommended by the doctor.

The ureteroscope will be inserted through the urethra into the bladder and up to where the stone is in the ureter. The stone will be grasped with tools or broken up with an ultrasonic/electrohydraulic probe. Once the stone is removed, a catheter or double-J stent will be placed temporarily.

1. You may see small amounts of blood in the urine. This problem should resolve within a few days following the procedure.
2. Unless contradicted you should drink 2 liters of clean water each day to prevent infection.
3. You may have some pain which should be relieved by simple analgesia.
4. The patient should inform the doctor right away if you have signs of infection or any of these symptoms: fever, offensive smelling urine, worsening pain on urination, severe pain or bloody urine lasts more than 2-3 days.

• Discomfort where the ureteroscope was inserted, which should go away after a couple of days. Local anesthesia may be given to ease your discomfort.
• Infection of the urinary tract, which is uncommon as antibiotics are often prescribed.
• Long-term complications include spasm of the ureters, which is found in less than one percent of patients.

• If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.
• Travelers to Thailand should plan to stay in the country for at least four days or for the entire duration of treatment.
• If you plan to return home after the procedure, please speak to your doctor before making travel arrangements. There are no restrictions for air travel.
• During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).

The procedure is usually successful, but kidney stones must also be treated because as long as there are stones in the kidneys, they can move to the ureter and the condition can recur. The best thing to do is to prevent kidney and ureteric stones by doing the following:

1. Drink plenty of clean water each day, a minimum of six to eight glasses. Some conditions, such as heart failure, may require that you limit your intake of water. Please discuss this with your doctor.
2. Limit foods that can lead to ureteric stones, such as:

• Foods high in oxalate, such as spinach, Swiss chard, collards, okra, parsley, leeks, and quinoa.
• Uric acid found in protein and certain vegetables.
• Cystine found in meat products.

3. Do not purchase over-the-counter vitamins and supplements, such as vitamin D, vitamin C, and calcium, without your doctor’s recommendation as these can lead to the formation of stones.

 
What if the procedure is not performed?
Pain will persist or the condition will lead to hydronephrosis. Without treatment, the kidneys may fail.
 

1. Medication, such as:

• Ureteric stones smaller than five millimeters that do not present any complications often pass on their own without intervention. You may receive the following instructions:
• Drink plenty of water and exercise as you normally do.
• Take pain medication as needed.
• You may have to return to the hospital if you exhibit any symptoms, such as fever or kidney changes, such as hydronephrosis. This will require a different treatment plan.
• Until the stone passes you may need a kidney, ureter and bladder (KUB) x-rays as well as ultrasound/intravenous pyelogram (IVP) if needed. You will be monitored until the stone has passed. It is important that you notice your urine for the stone’s appearance or you may bring the stone to the hospital to ensure it matches what appeared in the imaging studies.
• Supportive care and monitoring symptoms
• Narcotic pain relievers like morphine and pethidine.
• Non-narcotic pain relievers like tramadol, buprenorphine, and pentazocine.
• Antispasmodic medication like hyoscine-N-butylbromide, which can be administered orally or intravenously. It is fairly effective, but has side effects and should never be used in patients with prostate disorders or glaucoma.