Nephroscopy

Overview

What is nephroscopy?

Nephroscopy is a procedure to examine the inside of your kidney and to treat certain conditions in your upper urinary tract.

Nephroscopy is performed using a small instrument called a nephroscope. The thin, tube part of the nephroscope is inserted into your skin through a very small cut. The nephroscope has channels within it that provide a source of light, a telescope and an irrigation system (water system to flush the operation site). The nephroscope uses ultrasound or a laser probe to break apart the target (for example, kidney stones). Once broken apart, the pieces are suctioned out through one of the channels of the scope or pulled out through the scope with graspers.

Nephroscopy is a non-invasive procedure that reduces the need for traditional open surgery.

When is nephroscopy used?

Nephroscopy is especially useful in removing small kidney stones. In this procedure (called percutaneous nephrolithotomy or PCNL), a small cut is made in the skin. A nephroscope is used to remove stones measuring one-third of an inch (1 cm) or larger.

Nephroscopy is also used to:

• Remove kidney stone fragments.
• Remove small tumors.
• Remove foreign bodies, such as a stent that was previously placed.
• Remove kidney cysts (a fluid-filled pouches on or in your kidney).
• Treat ureteropelvic junction (UPJ) obstruction (a blockage in an area of your kidney called a the renal pelvis)
• Check to see if a previous PCNL procedure was successful and no kidney stones or fragments remain.

Where is nephroscopy performed?

On its own, as a diagnostic or follow-up procedure, nephroscopy can be done on an outpatient basis. If it’s performed along with PCNL, it’s done in a hospital. If you undergo PCNL, you’ll receive general anesthesia and recover in the hospital for one day.

How do I prepare for nephroscopy?

Your urine may be tested and you may need to take an antibiotic if your urine is infected.

If you take aspirin, you should stop taking it at least one week before your procedure. Other antiplatelet drugs and warfarin (Coumadin®) should be stopped as well. Your urologist will tell you when to stop taking these anti-clotting medications.

You should have nothing to eat or drink for 8 hours before your procedure.

How nephroscopy performed?

Your urologist will look at the recent scans (for example, CT scan or urogram) of your kidney and urinary tract to prepare for the procedure. You will be given general anesthesia and positioned on the operating table lying face down on your stomach.

A small catheter is placed through your urethra into your kidney. Dye is then injected into the catheter and X-rays are taken to show details of the inside of your kidney. A needle is inserted through the skin on your back into your kidney at the location determined in the pre-surgery planning. The area is dilated and a sheath (tube) is inserted through a dime-sized incision. The sheath allows the nephroscope – and other surgical instruments that are inserted through the nephroscope – direct access to the inside of your kidney. The target of the procedure (for example, kidney stone or blockage) is broken up and/or removed through the nephroscope.

A urethral stent is also placed in your kidney. A stent is a 10- to 12-inch soft, hollow plastic tube that is positioned the full length of your ureter. Your ureter is the duct that allows urine to pass from your kidney to your bladder. The stent holds your ureter open, which helps your body drain urine and encourages your kidney to heal. This stent is usually removed within week after the procedure in your doctor’s office.

What happens after the procedure?

You will be taken to a recovery room and monitored while you wake up from the anesthesia. You will be watched for internal bleeding. Antibiotic therapy will be continued.

When will I go home?

Depending on why you had a nephroscopy, you will likely go home the day after the procedure. Your doctor will discuss what the typical length of stay is for your condition.

What should I watch for?

• Call your doctor if you experience fever or chills or have pain that is not controlled with your prescription medication.
• Go to the emergency room if you see significant bleeding or blood clots in your urine.
• Avoid heavy lifting and strenuous exercise for two to four weeks unless told otherwise by your doctor.

What are the risks and benefits of nephroscopy?

Nephroscopy is a very safe procedure that reduces the need for traditional surgery, which involves a longer recovery time and greater risk of infection.

Risks include serious bleeding for which you’d need a transfusion; fluid buildup in your lungs, which would be drained by needle or tube; sepsis, a serious infection; urinary tract infection and injury to your ureter or kidney.