A bilateral ureteroscopy is an endoscopic procedure that addresses issues within the urinary tract on both the left and right sides during a single surgical session. The term “ureteroscopy” refers to the use of a thin, flexible telescope, called a ureteroscope, which is passed through the natural urinary opening, or urethra, and into the bladder. The scope is then advanced into the ureters, the narrow tubes that carry urine from the kidneys to the bladder. The addition of the term “bilateral” indicates that the surgeon performs this comprehensive examination and treatment on both the left and right ureters and kidneys simultaneously. This approach allows for the resolution of conditions affecting both sides of the upper urinary tract.
Why a Bilateral Approach is Necessary
The primary reason a doctor recommends a bilateral ureteroscopy is to manage issues, most commonly urinary stones, that are present in both the right and left urinary tracts at the same time. This is often reserved for patients who have a significant stone burden, meaning multiple or sizable stones, distributed across both kidneys and/or ureters. Treating both sides during a single procedure requires only one instance of general anesthesia, accelerating the patient’s overall recovery timeline and reducing the total time spent away from daily activities. Furthermore, addressing stones on both sides simultaneously helps to prevent potential future complications, such as a complete blockage of the urinary flow, which can cause severe pain and damage to the kidneys. While stone disease is the most frequent indication, a bilateral procedure may also be necessary for evaluating or treating other conditions, such as urothelial tumors or specific anatomical needs that affect both sides.
Detailed Steps of the Procedure
The entire bilateral ureteroscopy is performed under general anesthesia. Once the patient is positioned, the surgeon begins by gently inserting the thin, flexible ureteroscope through the urethra, advancing it into the bladder. Sterile fluid is continuously flushed through the scope to help expand the urinary tract and maintain clear visibility throughout the process.
From the bladder, the scope is maneuvered into the opening of the first ureter. The surgeon guides the scope along the ureter to locate the obstruction, such as a stone. If a stone is identified, a specialized laser fiber, typically a holmium laser, is passed through the working channel of the ureteroscope to break the stone into very small fragments, a process called laser lithotripsy.
Fragments are then removed using miniature grasping tools or a small wire basket. After the first side is cleared, the surgeon places a temporary ureteral stent, a hollow plastic tube that runs from the kidney down to the bladder. This stent keeps the ureter open, ensuring the kidney can drain urine properly and allowing the lining of the tube to heal. The surgeon then repeats the entire sequence of steps—insertion, visualization, stone fragmentation, removal, and stent placement—on the opposite side of the urinary tract to complete the bilateral treatment.
Expected Recovery and Follow-up
Following the procedure, patients are monitored briefly before being discharged, as ureteroscopy is often an outpatient procedure. The most significant aspect of recovery is managing the symptoms associated with the temporary ureteral stent. It is common to experience frequent and urgent needs to urinate, as the stent’s coil in the bladder can cause irritation. Pain is also frequently felt in the flank or side, particularly during urination.
Patients should expect to see blood in the urine, known as hematuria, which can persist intermittently as long as the stents remain in place. Patients should maintain a high fluid intake, aiming for around three liters of water daily, which helps flush the urinary system and minimize discomfort. Prescription pain medication and medications that help relax the urinary muscles, such as tamsulosin, are often provided to manage these symptoms.
The stents are temporary and must be removed, typically within 5 to 14 days following the surgery. Stent removal is a quick, second procedure, often performed in the clinic without anesthesia, where a small flexible scope is inserted into the bladder to grasp and pull the stent out. After the stents are removed, a follow-up appointment is scheduled to confirm that all stone fragments have been completely cleared from both kidneys and ureters.