Open removal of stone from the ureter

What is this?

This involves the removal of a stone in the ureter (the tube connecting the kidney to the bladder) with an incision in the side or abdomen & possible placement of plastic tube in ureter

What alternatives are there?

Telescopic removal, (telescopic or minimally-invasive) removal, shock wave treatment, observation to allow spontaneous passage

What to expect before procedure

You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. An X-ray to confirm the position of your stone(s) will normally be performed shortly before your operation. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. You will usually be given injectable antibiotics before the procedure, after checking for any allergies. The site of the incision will be determined by the position of your stone. This may be in just below your rib cage (for a stone in the upper ureter), in your flank (for a stone in the mid-section) or in your lower abdomen (for a stone in the lower third). The ureter is mobilised and an incision made into it through which the stone is removed. A wound drain is usually inserted at the end of the procedure, together with a bladder catheter to monitor urine output; it may also be necessary to insert a stent into the ureter at the time of surgery

After the procedure

You will be mobilised as soon as possible after the operation. The wound drain is normally removed when drainage ceases after 3-5 days and the bladder catheter is removed once you are mobile enough to go to the toilet to pass urine yourself. Absorbable stitches are usually used and do not require removal; If the stitches used are not absorbable, we will arrange for them to be removed either on the ward or by your District Nurse after 7-10 days. You may have a further X-ray after the procedure to confirm that the stone has been completely removed and to check the position of a ureteric stent If this has been inserted. The average hospital stay is 8 days.

Potential side effects