Ureteroscopy Workup

  • Author: Michael Grasso III, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Jan 19, 2012
 

Laboratory Studies

  • Coagulation factors
    • Prothrombin time
    • Activated partial thromboplastin time
    • Platelet count
  • Urinalysis for urine culture
  • Standard preoperative laboratory workup
    • CBC count
    • Electrolyte levels
    • Serum creatinine and BUN determination
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Imaging Studies

  • Useful preoperative imaging studies depending on the clinical presentation include the following:
    • Renal ultrasonography
    • IVP
    • CT scanning
    • MRI
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Michael Grasso III, MD  Director of Endourology, Lenox Hill Hospital; Professor and Vice Chairman, Department of Urology, New York Medical College

Michael Grasso III, MD is a member of the following medical societies: American Medical Association, American Urological Association, Endourological Society, Medical Society of the State of New York, National Kidney Foundation, Société Internationale d'Urologie (International Society of Urology), and Society of Laparoendoscopic Surgeons

Disclosure: Karl Storz Endoscopy Consulting fee Consulting; Boston Scientific Consulting fee Consulting; Cook Urologic Consulting fee Consulting

Coauthor(s)

Paul Pyo, MD  Staff Physician, Department of Urology, New York Medical College

Disclosure: Nothing to disclose.

G Blake Johnson, MD  Consulting Staff, Middleton Urology Associates

G Blake Johnson, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel B Rukstalis, MD  Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group

Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science and American Urological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dan Theodorescu, MD, PhD  Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer Center

Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology

Disclosure: Key Genomics Ownership interest Co-Founder-50% Stock Ownership; KromaTiD, Inc Stock Options Board membership

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Additional Contributors

Medscape Reference thanks Dennis G Lusaya, MD, Associate Professor II, Department of Surgery (Urology), University of Santo Tomas; Head of Urology Unit, Benavides Cancer Institute, University of Santo Tomas Hospital; Chief of Urologic Oncology, St Luke’s Medical Center Global City, Philippines, for the video contribution to this article.

Medscape Reference also thanks Edgar V Lerma, MD, FACP, FASN, FAHA, Clinical Associate Professor of Medicine, Section of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine; Research Director, Internal Medicine Training Program, Advocate Christ Medical Center; Consulting Staff, Associates in Nephrology, SC, for his assistance with the video contribution to this article.

References

  1. Marshall VF. Fiber Optics in Urology. J Urol. Jan 1964;91:110-4. [Medline].

  2. Bagley DH, Huffman JL, Lyon ES. Combined rigid and flexible ureteropyeloscopy. J Urol. Aug 1983;130(2):243-4. [Medline].

  3. Johnson GB, Portela D, Grasso M. Advanced ureteroscopy: wireless and sheathless. J Endourol. Aug 2006;20(8):552-5. [Medline].

  4. Aboumarzouk OM, Kata SG, Keeley FX, Nabi G. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev. Dec 7 2011;12:CD006029. [Medline].

  5. Chen GL, Bagley DH. Ureteroscopic surgery for upper tract transitional-cell carcinoma: complications and management. J Endourol. May 2001;15(4):399-404; discussion 409. [Medline].

  6. Lee D, Trabulsi E, McGinnis D, Strup S, Gomella LG, Bagley D. Totally endoscopic management of upper tract transitional-cell carcinoma. J Endourol. Feb 2002;16(1):37-41. [Medline].

  7. Blute ML, Segura JW, Patterson DE. Ureteroscopy. J Urol. Mar 1988;139(3):510-2. [Medline].

  8. Grasso M, Bagley D. Small diameter, actively deflectable, flexible ureteropyeloscopy. J Urol. Nov 1998;160(5):1648-53; discussion 1653-4. [Medline].

  9. Abdel-Razzak OM, Bagley DH. Clinical experience with flexible ureteropyeloscopy. J Urol. Dec 1992;148(6):1788-92. [Medline].

  10. Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: current practice and long-term complications. J Urol. Jan 1997;157(1):28-32. [Medline].

  11. Bagley D. Active versus passive deflection in flexible ureteroscopy. J Endourol. 1987;1:15.

  12. Bagley DH. Intrarenal access with the flexible ureteropyeloscope: effects of active and passive tip deflection. J Endourol. Jun 1993;7(3):221-4. [Medline].

  13. Bagley DH. Removal of upper urinary tract calculi with flexible ureteropyeloscopy. Urology. May 1990;35(5):412-6. [Medline].

  14. Bagley DH. Ureteral endoscopy with passively deflectable, irrigating flexible ureteroscopes. Urology. Feb 1987;29(2):170-3. [Medline].

  15. Bagley DH, Allen J. Flexible ureteropyeloscopy in the diagnosis of benign essential hematuria. J Urol. Mar 1990;143(3):549-53. [Medline].

  16. Bagley DH, Huffman JL, Lyon ES. Flexible ureteropyeloscopy: diagnosis and treatment in the upper urinary tract. J Urol. Aug 1987;138(2):280-5. [Medline].

  17. Bagley DH, Liu JB, Goldberg BB, Grasso M. Endopyelotomy: importance of crossing vessels demonstrated by endoluminal ultrasonography. J Endourol. Dec 1995;9(6):465-7. [Medline].

  18. Bagley DH, Rivas D. Upper urinary tract filling defects: flexible ureteroscopic diagnosis. J Urol. Jun 1990;143(6):1196-200. [Medline].

  19. Berci G. Instrumentation: flexible fiber endoscopes. In: Berci G, ed. Endoscopy. New York, NY: Appleton-Century-Crofts; 1976.

  20. Bierkens AF, Hendrikx AJ, De La Rosette JJ, Stultiens GN, Beerlage HP, Arends AJ, et al. Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness. Br J Urol. Jan 1998;81(1):31-5. [Medline].

  21. Conlin M, Bagley DH. Incisional treatment of ureteral strictures. In: Smith AD, Lingeman JE, Bagley DH, Preminger GM, Clayman RV, Badlani GH, Jordan GH, Kavoussi LV, Segura JW, eds. Smith's Textbook of Endourology. Vol 1. St Louis, Mo: Quality Medical Publishing; 1996:497-505.

  22. Conlin MJ, Bagley DH. Ureteroscopic endopyelotomy at a single setting. J Urol. Mar 1998;159(3):727-31. [Medline].

  23. Denstedt JD, Clayman RV. Electrohydraulic lithotripsy of renal and ureteral calculi. J Urol. Jan 1990;143(1):13-7. [Medline].

  24. Elbahnasy AM, Shalhav AL, Hoenig DM, Elashry OM, Smith DS, McDougall EM, et al. Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy. J Urol. Mar 1998;159(3):676-82. [Medline].

  25. Erhard M, Salwen J, Bagley DH. Ureteroscopic removal of mid and proximal ureteral calculi. J Urol. Jan 1996;155(1):38-42. [Medline].

  26. Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intrarenal calculi. J Urol. Apr 1998;159(4):1139-43. [Medline].

  27. Goodman TM. Ureteroscopy with pediatric cystoscope in adults. Urology. Apr 1977;9(4):394. [Medline].

  28. Grasso M. Experience with the holmium laser as an endoscopic lithotrite. Urology. Aug 1996;48(2):199-206. [Medline].

  29. Grasso M. Resecting upper-tract urothelial Ca by ureteroscopy. Contemp Urol. Dec 1993;5(12):52-9. [Medline].

  30. Grasso M. Flexible Fiberoptic Ureteropyeloscopy. In: Smith AD, Lingeman JE, Bagley DH, Preminger GM, Clayman RV, Badlani GH, Jordan GH, Kavoussi LV, Segura JW, eds. Smith's Textbook of Endourology. Vol 1. St Louis, Mo: Quality Medical Publishing; 1996:443-54.

  31. Grasso M. Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am. Nov 2000;27(4):623-31. [Medline].

  32. Grasso M, Bagley D. A 7.5/8.2 F actively deflectable, flexible ureteroscope: a new device for both diagnostic and therapeutic upper urinary tract endoscopy. Urology. Apr 1994;43(4):435-41. [Medline].

  33. Grasso M, Bagley DH. Flexible ureteroscopic lithotripsy using pulsed-dye laser. J Endourol. 1990;4:155.

  34. Grasso M, Conlin M, Bagley D. Retrograde ureteropyeloscopic treatment of 2 cm. or greater upper urinary tract and minor Staghorn calculi. J Urol. Aug 1998;160(2):346-51. [Medline].

  35. Grasso M, Ficazzola M. Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol. Dec 1999;162(6):1904-8. [Medline].

  36. Grasso M, Fraiman M, Levine M. Ureteropyeloscopic diagnosis and treatment of upper urinary tract urothelial malignancies. Urology. Aug 1999;54(2):240-6. [Medline].

  37. Grasso M, Lang G, Loisides P, Bagley D, Taylor F. Endoscopic management of the symptomatic caliceal diverticular calculus. J Urol. Jun 1995;153(6):1878-81. [Medline].

  38. Grasso M, Liu JB, Goldberg B, Bagley DH. Submucosal calculi: endoscopic and intraluminal sonographic diagnosis and treatment options. J Urol. May 1995;153(5):1384-9. [Medline].

  39. Grasso M, Loisides P, Beaghler M, Bagley D. The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock-wave lithotripsy failures. Urology. Mar 1995;45(3):363-71. [Medline].

  40. Grotas A, Grasso M. Endoluminal sonographic imaging of upper urinary tract: three-dimensional reconstruction. J Endourol. Jun 2001;15(5):485-8. [Medline].

  41. Hudson RG, Conlin MJ, Bagley DH. Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope. BJU Int. May 2005;95(7):1043-4. [Medline].

  42. Johnson GB, Fraiman M, Grasso M. Broadening experience with the retrograde endoscopic management of upper urinary tract urothelial malignancies. BJU Int. Mar 2005;95 Suppl 2:110-3. [Medline].

  43. Johnson GB, Grasso M. Exaggerated primary endoscope deflection: initial clinical experience with prototype flexible ureteroscopes. BJU Int. Jan 2004;93(1):109-14. [Medline].

  44. Keeley FX Jr, Bibbo M, Bagley DH. Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J Urol. May 1997;157(5):1560-5. [Medline].

  45. Keeley FX, Kulp DA, Bibbo M, McCue PA, Bagley DH. Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol. Jan 1997;157(1):33-7. [Medline].

  46. Kumon H, Tsugawa M, Matsumura Y, Ohmori H. Endoscopic diagnosis and treatment of chronic unilateral hematuria of uncertain etiology. J Urol. Mar 1990;143(3):554-8. [Medline].

  47. Lam JS, Gupta M. Ureteroscopic management of upper tract transitional cell carcinoma. Urol Clin North Am. Feb 2004;31(1):115-28. [Medline].

  48. Liu JB, Bagley DH, Conlin MJ, Merton DA, Alexander AA, Goldberg BB. Endoluminal sonographic evaluation of ureteral and renal pelvic neoplasms. J Ultrasound Med. Aug 1997;16(8):515-21; quiz 523-4. [Medline].

  49. Lyon ES, Banno JJ, Schoenberg HW. Transurethral ureteroscopy in men using juvenile cystoscopy equipment. J Urol. Aug 1979;122(2):152-3. [Medline].

  50. McMurtry JM, Clayman RV, Preminger GM. Endourological diagnosis and treatment of essential hematuria. J Endourol. 1987;1:145.

  51. Preminger GM, Kennedy TJ. Ureteral stone extraction utilizing non-deflectable flexible fiberoptic ureteroscopes. J Endourol. 1987;1:31.

  52. Razdan S, Johannes J, Cox M, Bagley DH. Current practice patterns in urologic management of upper-tract transitional-cell carcinoma. J Endourol. Apr 2005;19(3):366-71. [Medline].

  53. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. The American Urological Association Nephrolithiasis Clinical Guidelines Panel. J Urol. Jun 1994;151(6):1648-51. [Medline].

  54. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol. Nov 1997;158(5):1915-21. [Medline].

  55. Soderdahl DW, Fabrizio MD, Rahman NU, Jarrett TW, Bagley DH. Endoscopic treatment of upper tract transitional cell carcinoma. Urol Oncol. Mar-Apr 2005;23(2):114-22. [Medline].

  56. Stoller ML, Wolf JS Jr, Hofmann R, Marc B. Ureteroscopy without routine balloon dilation: an outcome assessment. J Urol. May 1992;147(5):1238-42. [Medline].

  57. Streem SB, Pontes JE, Novick AC, Montie JE. Ureteropyeloscopy in the evaluation of upper tract filling defects. J Urol. Aug 1986;136(2):383-5. [Medline].

  58. Suh RS, Faerber GJ, Wolf JS Jr. Predictive factors for applicability and success with endoscopic treatment of upper tract urothelial carcinoma. J Urol. Dec 2003;170(6 Pt 1):2209-16. [Medline].

  59. Takagi T, Go T, Takayasu H, Aso Y, Hioki R. Small-caliber fiberscope for visualization of the urinary tract, biliary tract, and spinal canal. Surgery. Dec 1968;64(6):1033-8. [Medline].

  60. Tawfiek ER, Liu JB, Bagley DH. Ureteroscopic treatment of ureteropelvic junction obstruction. J Urol. Nov 1998;160(5):1643-6; discussion 1646-7. [Medline].

  61. Teichman JM, Champion PC, Wollin TA, Denstedt JD. Holmium:YAG lithotripsy of uric acid calculi. J Urol. Dec 1998;160(6 Pt 1):2130-2. [Medline].

  62. Wollin TA, Teichman JM, Rogenes VJ, Razvi HA, Denstedt JD, Grasso M. Holmium:YAG lithotripsy in children. J Urol. Nov 1999;162(5):1717-20. [Medline].

 
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Flexible fiberoptic ureteropyeloscope.
Secondary endoscope deflection that allows lower-pole intrarenal access.
Plain radiograph that defines a large renal pelvic calculus with the flexible ureteroscope passed beyond the stone burden.
The instillation of radiopaque contrast material through the working channel of the flexible ureteroscope defines the lower-pole location of the tip of the endoscope.
Ureteroscopic image of an impacted jack stone in the ureter. These calculi are composed of calcium oxalate monohydrate.
Ureteroscopic image of a papillary transitional cell carcinoma of the ureter.
Ureteroscopy and laser lithotripsy. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
Table 1. Comparison of Complication Rates Associated With Ureteroscopy, Emphasizing the Noticeable Decrease in the Major Complication Rate With Greater Experience and Endoscope Miniaturization
AuthorBlute et al[7] Abdel-Razzak and Bagley[9] Harmon et al[10] Grasso and Bagley[8]
Year Published1988199219971998
Procedures346290209584
Minor Complications, %
Colic/pain---93.55.5
Fever6.26.921.4
False passage0.9------0.4
Hematuria
Minor



Prolonged



0.5



0.3



2.1



1



0



0



0.7



0.2



Extravasation0.61------
Urinary tract infection---1---1.6
Pyelonephritis---------0.5
Major Complications, %
Perforation4.61.710
Stricture1.40.70.50.5
Avulsion0.6000
Urinoma0.6---00
Urosepsis0.3000
Cardiovascular accident------0.50.2
Deep vein thrombosis---------0.2
Table 2. New York University Experience With Ureteroscopic Treatment of Ureteral Calculi Using the Holmium:YAG Laser
SegmentNumber of CasesMean Diameter,



mm (range, mm)



Success Rate,



First-Stage Treatment



and Second -Stage Treatment



Proximal third7511.3 (30-5)95% and 96%
Middle third4510.7 (60-5)98% and 100%
Distal third9110.3 (50-4)99% and 100%
Totals21197% and 99%
Table 3. New York University Experience With Ureteropyeloscopic Treatment of Intrarenal Calculi Using the Holmium:YAG Laser
LocationNumber of CasesMean Diameter,



mm (range, mm)



Success Rate, Treatment



and Multistage Treatment



Upper pole5810.6 (35-4)90% and 97%
Middle pole3011.1 (23-4)90% and 93%
Lower pole10314.8 (40-3)79% and 85%
Renal pelvic3720.5 (60-6)78% and 95%
Totals22881% and 90%
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