One of India’s most common problems is stone in ureter (tube draining urine from kidney into bladder). All ureteric stones start as kidney stones. Some stones may pass out of the kidney or get lodged in the ureter and cause severe pain that starts from the lower back and radiates to the side or groin. A lodged stone can block the flow of urine and build a backpressure in the affected ureter and kidney. Increased pressure results in stretching and spasm, which cause severe pain. Various factors responsible for stone formation are insufficient fluid intake, excessive calcium and other salts in diet, high concentration of calcium and other salts in urine and obstruction or infection in the urinary system.

Sometimes ureteric stone does not cause any symptom (silent stone). Generally the symptoms are:

• • Strong or dull pain in the upper back or side
• • Nausea and vomiting
• • Blood in the urine
• • Burning sensation while urinating
• • Fever and rigor or chills
• • Signs of kidney failure

Diagnosis of stone is mainly radiological with ultrasound and x-rays. Laboratory Tests are performed to look for urine infection and function of the kidneys:

• • Complete Blood Count
• • Serum Creatinine
• • Urine microscopy and culture
• • X Ray abdomen and pelvis
• • Ultrasound KUB
• • IVU (Intravenous Urography)
• • CT Urography

Holmium Laser URS

In this procedure, the world's thinnest 4.5 Fr ureteroscope is passed under anesthesia per urethra into bladder and ureter up to the stone. Small stones are pulled out with various instruments and bigger stones are fragmented with high energy Holmium laser machine into smaller pieces which subsequently pass naturally. Sometimes, soft tube (Stent) is left in the ureter temporarily.

We are one of the pioneers in offering the ureteroscopy treatment in India since 2008 and have over 1500 successful cases to our credit.

Advantages

• • 12 hour hospitalisation, usually
• • Minimal post-operative discomfort and complications due to the use of thinnest ureteroscope (4.5 Fr)
• • With Holmium Laser, the fragmentation is more accurate and the chances of stone going up into the kidney are much smaller
• • Hard and large stones can be broken easily with minimal trauma on ureter Mucosa.
• • Higher rate of complete clearance reducing need for lithotripsy

Advantages of URS with Holmium Laser vs. URS with pneumatic lithotripter

URS with Holmium Laser	URS with Pneumatic Lithotripter
Minimal chance of upward migration of stone during treatment	High chance of upward migration of stone during treatment
Very effective for soft as well as hard stones	Less effective for hard stones
No mucosal injury or bleeding during treatment	Some mucosal injury or bleeding during treatment
Reduced need for D J stent	Higher need for D J stent
Used with rigid and flexible URS	Used only with rigid URS