Ureteroscopy with vacuum aspiration.

What's new

For most stones in the ureter and kidney, the standard treatment is flexible ureteroscopy with laser lithotripsy — a thin scope passed through the urethra up into the kidney, with a laser fiber to break the stone into fragments that either pass on their own or are removed with a basket. Traditionally, this was best suited to stones up to about 2 cm.

The newest generation of this surgery adds active vacuum aspiration — a suction system integrated into the scope sheath that continuously removes stone fragments and dust as they are produced. Dr. Ursiny performs vacuum-assisted ureteroscopy using contemporary suction systems (e.g., Calyxo/CVAC, ClearPetra). This has changed what ureteroscopy can do: stones well above 3 cm — many that would previously have required PCNL — can now be cleared through a scope, with no incision. The benefits:

• Higher stone-free rates in a single procedure
• Shorter operative times
• Lower intrarenal pressure during the case — a major safety advantage
• Less reliance on hoping small fragments pass on their own afterward

Who it is for

• Ureteral stones not suitable for shockwave, or that have failed it
• Larger kidney stones — including many above 3 cm that once required PCNL
• Patients on blood thinners — ureteroscopy is the safest stone surgery in this group, and most patients can stay on their blood thinners through the procedure
• Anatomically unfavorable lower-pole stones
• Patients in whom prior stone surgery left residual fragments

What the day looks like

• General anesthesia
• Outpatient — you go home the same day
• Operative time: about 30 to 75 minutes depending on stone burden
• An internal ureteral stent is placed at the end of the procedure in nearly all cases
• The stent is removed in a brief office procedure, usually 4–7 days later

Recovery

• Most people return to desk work within 2–3 days
• The internal stent can cause flank or bladder discomfort while it is in place — typically very manageable
• Stent removal is quick (under 5 minutes) and immediately relieves stent discomfort

Risks worth knowing

• Stent discomfort while it is in place
• Blood in the urine for a few days — common and harmless
• Urinary tract infection — uncommon with pre-procedure culture and targeted antibiotics
• Ureteral injury — rare; vacuum aspiration reduces intrarenal pressure and lowers this risk
• Residual fragments — much less common with active aspiration than with older techniques