Ureterorenoscopy with lithotripsy (URS)

According to the European Association of Urology (EAU) guidelines, urethenorenoscopy with lithotripsy (URS) should be considered as the first choice option for cases of ureteral stones in which spontaneous stone expulsion has not occurred. In particular, it is the gold standard for ureteral calculi above 10mm in size regardless of the localization of the stone, while in stones smaller than 10mm uretenorenoscopy can be used in a manner comparable to shock wave lithotripsy (ESWL). It is also recommended as the first choice treatment for kidney stones up to 2 cm that merit surgical treatment.

Cases in which active ureteral stone removal is indicated are:

• Calculi that are unlikely to be expelled spontaneously;
• Persistent colic pain despite adequate drug therapy;
• Renal obstruction;
• Renal insufficiency.

While cases where active removal of kidney stones is indicated are:

• Calculus increased in size;
• Obstruction;
• Infection;
• Symptomatic patient;
• Calculi >15mm.

Ureterorenoscopy (URS) is an endoscopic procedure (which therefore does not involve skin incisions) that uses a special endoscopic instrument, the ureterorenoscope.

This instrument, passing through the external urethral meatus, the urethra and the bladder reaches the ureter and the kidney, allowing to visualize these structures and to identify the presence of both suspicious lesions in the heteroformative sense (tumors of the upper excretory tract) and stones.

Once the stone has been identified, it can be crushed using a Holmium laser (Holmium laser lithotripsy) or with the aid of shock waves (Lithoclast). At the end of the procedure, a ureteral catheter (double J type) is usually placed to ensure proper outflow of urine along the ureter. This catheter is then removed on an outpatient basis after a period of time that varies depending on the case and is usually between 10-30 days.