• Open Ureterolithotomy

    (Removal of Stones in Ureter)

    Definition

    An open ureterolithotomy is a surgery to remove stones from the ureter.
    The ureter is a tube between the kidney and the bladder. Urine passes down to the bladder through this tube.
    The Urinary Tract
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Ureterolithotomy is used to remove stones in a ureter that:
    • Are too large to pass
    • Cause pain or bleeding
    • Cause infection
    • Block the flow of urine
    • Place pressure on the kidney

    Possible Complications

    Problems from this surgery are rare, but all surgeries have some risk. Your doctor will review potential problems. Complications associated with any surgery include:
    • Adverse reaction to anesthesia, including light-headedness, low blood pressure, or wheezing
    • Infection
    • Excess bleeding
    • Heart attack or stroke
    • Blood clots
    • Death
    Complications associated with ureterolithotomy include:
    • Excess scarring or narrowing in the ureter that can lead to kidney problems
    • Failure to remove the kidney stone
    • Problems urinating such as:
      • Urine leaking from the ureter
      • Difficulty passing urine, especially in men
      Bowel complications:
      • May be blocked or paralyzed after surgery leading to bloating and vomiting
      • Scar tissue around bowels that can cause later blockages
    • Excess scarring of incision
    • Hernia
    Smoking may increase your risk of complications.
    Talk to your doctor about these risks before the procedure.

    What to Expect

    Prior to Procedure

      Your doctor may take the following:
      • Images of your urinary system to locate the stone
      • Blood and urine tests
      • Ask about your medical history
    • Talk to your doctor about any medicines you are taking. Do not start taking any new medicines, herbs, or supplements without talking to your doctor.
    • You may be asked to stop taking some medicines up to one week before the procedure. This may include medications such as:
      • Anti-inflammatory medications
      • Blood thinners
      • Anti-platelet medications
    • Arrange for a ride from the hospital. Arrange for help at home as you recover.
    • The night before your surgery, eat a light meal. Do not eat or drink anything after midnight unless told otherwise by your doctor.

    Anesthesia

    General anesthesia will be used. You will be asleep. It is given through a vein in the arm or hand.

    Description of the Procedure

    An incision will be made in your side or abdomen. The incision location will depend on exactly where the stone is. Both muscle and skin will need to be cut to expose the ureter. The stone will be located in the ureter. An incision will be made in the ureter just above the stone. The stone will then be removed. A stent may be placed in the ureter. This is a device to help keep the ureter open. The ureter will then be sewn shut with stitches. The muscles and skin will then be sewn shut with stitches or staples. A tube may be placed in the wound. It will help drain out any extra fluids while the wound heals.
    The stone may be sent to a laboratory for testing.

    Immediately After Procedure

    After the operation, you will be taken to the recovery room for observation. X-rays may be taken to make sure the stone was completely removed.

    How Long Will It Take?

    About 60-90 minutes

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. Your doctor will give you medicine to help manage pain during recovery.

    Average Hospital Stay

    You may need to stay in the hospital for about three to four days. If you have any problems, you may need to stay longer.

    Post-procedure Care

    At the Hospital
    • You may need oxygen for a brief time after your operation.
    • You will have a tube near your incision. It will be removed once fluid stops draining from the wound. This generally happens within three to four days of surgery.
    • You may have an IV until you are eating and drinking normally.
    • You will have a catheter that will drain your urine until you are able to move around on your own.
    • You will be given pain medicine as needed.
    • You may be encouraged to exercise by walking the day after surgery.
    • You may be given blood thinning medication to prevent clots.
    At Home
    It can take four to six weeks to fully recover from this procedure. When you return home, take these steps:
    • Get plenty of rest. Gradually resume activities.
    • Drink plenty of fluids.
    • Follow your doctor’s instructions on cleaning the incision site.
    • Ask your doctor when you can drive and return to work.
    • Ask your doctor when it is safe to have sex.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Take medication as directed by your doctor.
    Be sure to follow your doctor’s instructions.

    Call Your Doctor

    Call your doctor if any of these occur:
    • Extreme urge or inability to urinate
    • Excess bleeding
    • Bruising
    • Redness or swelling at the site of the incision
    • Pus draining from the site of the incision
    • Signs of infection, including fever and chills
    • Nausea and/or vomiting that you cannot control with the medicines you were given after the procedure
    • Pain that you cannot control with the medicines you have been given
    • Cough, shortness of breath, or chest pain
    If you have an emergency, call for medical help right away.

    RESOURCES

    National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

    National Kidney Foundation http://www.kidney.org

    Urology Care Foundation http://www.urologyhealth.org

    CANADIAN RESOURCES

    Canadian Urological Association http://www.cua.org

    The Kidney Foundation of Canada http://www.kidney.ca

    References

    Kidney stones in adults. National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/KUDiseases/pubs/stonesadults/index.aspx#treatment . Updated June 29, 2012. Accessed January 15, 2013.

    Skrepetis K, Doumas K, et al. Laparoscopic versus open ureterolithotomy. A comparative study. Eur Urol . 2001;40(1):32-6.

    Ureterolithotomy—dormia basket. Netdoctor website. Available at: http://www.netdoctor.co.uk/surgical-procedures/ureterolithotomy-dormia-basket.htm . Updated June 7, 2009. Accessed January 15, 2013.

    Ureterolithotomy (open) consent form. Queensland Government website. Available at: http://www.health.qld.gov.au/consent/documents/urology%5F21.pdf . Published March 2011. Accessed January 15, 2013.

    Ureterolithotomy (removal of ureteric stone). The Pennine Acute Hospitals website. Available at: http://www.pat.nhs.uk/CubeCore/.uploads/Media%20Library/Abdomen/Urology/20120711%5F288%20Ureterolithotomy.pdf . Accessed January 15, 2013.

    Patient Information: Open removal of stone from ureter. Addenbrooke’s Hospital NHS website. Available at: http://www.camurology.org.uk/wp-content/uploads/ureterolithotomy-44.pdf . Accessed January 23, 2013.

    Revision Information

    • Reviewer:
    • Review Date: 06/2013
    • Update Date: 06/25/2013
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