Semi-rigid ureteroscopy.
A thin device is introduced through the urethra and reaches the ureter, where the stone can be fragmented and removed.
Endourology
Surgeries to treat urinary stones (endourology)
The location and characteristics of the stone guide the technique.
Assessment and indication
Every decision starts with understanding the case.
Endourology allows the treatment of many urinary stones with instruments introduced through the urethra or through a small access to the kidney. The choice of technique depends on the location and size of the stone, the anatomy of the urinary tract and the patient's condition.
Not every calculation needs to be operated. A small stone in the ureter can be passed spontaneously. In other cases, persistent pain, obstruction, stone growth, or risk to the kidney make intervention necessary.
01
How do I evaluate
I analyze symptoms, urine tests, kidney function and images. When indicated, tomography helps to define where the stone is, its size and density. I also try to find out if the patient has had other stones, infections or surgeries in the urinary tract.
If there is an infection associated with the obstruction, the priority is to drain the urine and treat the infection. Permanent surgery to remove the stone is performed after this condition is controlled.
02
What are the techniques?
Flexible ureteroscopy, or retrograde intrarenal surgery.
A flexible device runs through the urinary tract to the inside of the kidney. Allows you to reach calculations in different regions, without an external incision.
Laser fragmentation.
The holmium laser and thulium fiber laser are options for fragmenting stones during endoscopic surgery. The choice depends on the characteristics of the stone, the technique used and the equipment available.
Percutaneous renal surgery.
For larger or more complex stones, it may be necessary to create a small access through the back to the kidney. In this way, the fragments are removed using specific instruments. The size of the access and the technique are defined as appropriate.
Vacuum systems.
In selected procedures, suction devices can help remove fragments, improve vision during surgery, and control the flow of fluid within the kidney.
Extracorporeal shock wave lithotripsy.
In appropriate cases, it is possible to fragment the stone by waves applied to the outside of the body, without introducing a device into the urinary tract. The location, size and density of the stone influence the chance of success.
Double J catheter.
In most endoscopic surgeries to treat stones, I temporarily use a double-J catheter to ensure urine drainage while the ureter recovers. Before the procedure, I explain the symptoms it can cause and when it will be removed.
03
Recovery and prevention
Recovery varies depending on the procedure. Burning urination, some blood in the urine, or discomfort caused by double J may occur after endoscopic surgery. Percutaneous surgery has its own precautions, which I explain before the operation.
My objective does not end with removing the stone. Whenever possible, I request analysis of the stone and assess the risk of recurrence. In patients who repeatedly form stones, a metabolic investigation can help identify treatable factors and guide prevention.
Consultation and planning
The indication is defined for each patient.
During the consultation, I evaluate the diagnosis, explain the alternatives and organize treatment and follow-up according to the needs of the case.