In recent years, flexible ureteroscopy combined with holmium laser lithotripsy has been widely used in the minimally invasive treatment of urinary stone, and has become an important surgical method for the treatment of upper urinary tract stone. It is minimally invasive, and can treat upper ureteral and intrarenal stone at the same time. Currently, it is the main treatment method for kidney stone below 2cm. However, there are also many cases of successful lithotripsy of kidney stone above 2 cm through flexible ureteroscope.

Flexible ureteroscopy can also deal with kidney stones with lower hardness, because they are easier to be broken by holmium laser. However, some hard stones, such as calcium oxalate monohydrate stones and cystine stones, are more difficult to break and may require two-stage flexible endoscopic surgery for reprocessing. The broken stones need to be completely excreted through our thin ureter, in order to achieve stone removal. At the same time, we need to consider comprehensively the economic cost of multiple operations, the mental and psychological pressure during the period, the prolonged treatment cycle, and the travel costs.

(1) Who is suitable for flexible ureteroscopy?

According to international and domestic urology guidelines, flexible ureteroscopy is suitable for some calculi above 1.5cm in the upper ureter and 2cm in kidney stones. There are also some patients with stones larger than 2 cm, who can achieve perfect stone clearing through flexible ureteroscopy. In addition, for some special cases, such as people with old age, low cardiopulmonary function, iodine allergy, flexible ureteroscopy is relatively safer.

(2) Is flexible ureteroscopic surgery a minimally invasive surgery? Is there any risk?

Flexible ureteroscopy is theoretically a minimally invasive surgery, but in practice, there are still a certain proportion of complications, such as ureteral injury, postoperative bleeding, postoperative infection, residual stones, inaccessible stones, long-term ureteral narrow possibilities. This has a great relationship with the specific doctor's technique and experience, the patient's ureteral condition and stone condition, the degree of preoperative hydronephrosis, the ureteral twist and stenosis, the renal function, and the patient's general condition. Therefore, any surgery, even if it is minimally invasive, has certain surgical risks.

(3)What preparation do I need?

The procedure will be done under General Anaesthesia so you will have to attend a pre assessment clinic before your operation. You will be screened for MRSA and some baseline investigations will be performed. You will also have an x-ray done to confirm the presence of a stone. You will be asked not to eat and drink around 6 hours prior to surgery.

(4) What happens on the day?

You will be admitted onto the ward on the day of your procedure and be seen by an anaesthetist. You will also be seen by the surgeon who will go through with you the procedure. You will have the opportunity to ask any questions. Your surgeon will also ask you to sign a consent form.

Your nurse will ask you to change into a hospital gown and remove any jewellery. You will be escorted to the theatre by the theatre staff nearer the time for your procedure.

(5)What happens after the procedure?

You will be seen either by the surgeon or a member of the team on the ward who will explain the outcome. You might come back to the ward with a catheter which will either be removed on the same day or next day morning. You will be able to go home once you are passing urine normally. If you have a stent in then you will have a further appointment made for removal of stent.