URSL Surgery - Purpose, Procedure, Benefits, Side Effects

URSL full form is ureteroscopy with lithotripsy. It is a minimally invasive surgery used to remove kidney stones lodged in the ureter (carry urine from the kidneys to the bladder). It involves two procedures: 

1. Ureteroscopy: A ureteroscope (small, flexible telescope) is used to locate the stone inside the ureter. 

2. Lithotripsy: A laser or shock wave is used to break the stone into tiny pieces. 

Anatomy and Physiology of the Kidney

The kidneys are two bean-shaped organs on both sides of the spine. They are situated below the rib cage and are approximately the size of a fist. 

Each kidney consists of an outer cortex and an inner medulla. These sections contain nephrons, the functional units of the kidneys. The organs receive blood from the renal artery, and the filtered blood leaves through the renal vein.

The functions of the kidney are as follows: 

1. Excretion of waste products in the urine 

2. Reabsorption of essential nutrients from blood 

3. Maintaining the pH balance of the body 

4. Achieving the fluid and electrolyte balance 

5. Regulating blood pressure

URSL is typically recommended for stones too large to pass through the urinary tract naturally. It may be performed for individuals who experience the following symptoms due to kidney stones: 

1. Recurrent urine tract infections

2. Blockage of urine flow 

3. Severe pain during urination 

4. Decreased frequency of urination 

5. Pain in the abdomen 

The ureteroscopic lithotripsy surgery is performed under general anaesthesia. Completed within 30 to 90 minutes, it involves the following URSL procedure steps:

1. A ureteroscope is inserted through the urethra and passed through the bladder to reach the ureter or kidney.

2. After the stone is located, it is treated with a laser to break it into smaller, manageable pieces.

3. Fragments of the stone are either retrieved using a basket-like device inserted through the ureteroscope or left to pass naturally in the urine.

4. Sometimes, a DJ stent (a ureteral stent used to treat urinary tract disorders) may be placed temporarily within the ureter to facilitate the passage of stone fragments.

5. Once all stones have been treated or removed, the ureteroscope is withdrawn.

Patients consult with a urologist to prepare for their URSL procedure. The specialist offers detailed instructions that must be followed both before and on the day of the surgery.

Before URSL

During the initial urologist consultation, patients ask questions and address concerns regarding the procedure. The medical expert explains the steps involved in the surgery. Preparations before URSL include:

On the Day of URSL

Individuals should arrange for someone to drive them home after the procedure. Once they reach the hospital, the following preparations take place:

It is normal to experience pain while urinating and a small amount of blood in the urine for the next 24 hours after the procedure. Patients should follow their doctor’s instructions in the hospital and at home to ensure a quick and smooth recovery. 

In Hospital Recovery 

After ureteroscopic lithotripsy, patients can return home on the same day once the effect of anaesthesia wears off. This could take one to four hours. During this hospital stay, one can expect the following: 

1. Individuals are taken to a recovery room where the nursing staff checks their vitals, including breathing and blood pressure. 

2. Discomfort is often managed with prescribed pain relievers. 

3. Drinking water for the next two hours is important to help flush out any remaining stone fragments. 

At-home Recovery 

Patients can expect to feel better within 5-7 days after the URSL procedure. Once they reach home, they should follow these guidelines: 

1. Rest for 24 hours.  

2. Take prescribed antibiotics for 4-5 days to prevent infection and pain relievers to manage discomfort. 

3. Drink four to six glasses of water daily to remove stone remnants from the urinary tract. 

4. Avoid strenuous activities for one week to prevent bleeding. 

Follow-up Appointment

The first follow-up appointment is scheduled for 7-10 after the surgery. During this visit, the urology doctor performs imaging tests like ultrasound or X-ray to ensure all stone fragments have been removed or passed. These also confirm that no new stones have formed and that the urinary tract is healing well.

If a ureteral stent was placed during the procedure, it will be removed at this visit. 

URSL is a highly efficient approach to managing kidney and ureter stones. According to a study by Bhatia et al., 2019, the success rate of the procedure in single lower ureteric stones is about 75%. The benefits of the surgery over traditional operations are as follows: 

1. No incisions or stitches 

2. Reduced pain and bleeding after surgery 

3. Shorter hospital stays 

4. Faster recovery 

5. Low rate of complications like infections 

"In my practice, I've seen URSL offer transformative relief for patients with kidney or ureter stones. Symptoms like severe pain, urinary blockage, and recurring infections can improve quality of life. URSL, with its minimal invasiveness and rapid recovery, provides an effective remedy. Timely intervention is crucial to prevent worsening symptoms and potential kidney damage. Therefore, I prioritise suggesting patients get URSL surgery done to regain comfort and health swiftly."

- Dr. Deepak Sharma
Urologist

URSL is considered a relatively safe procedure. According to Murtadha et al., 2019, the risk of major complications after the procedure is 0.8% to 1.5%. The risks may include the following: 

1. Urinary tract infection 

2. Bleeding 

3. Ureteral injury 

4. Narrowing or scarring of the ureter 

5. Adverse reaction to anaesthesia 

6. Difficulty breathing 

When to call a doctor?

After undergoing URSL, patients should monitor their recovery and be alert for signs of complications. It is important to contact the urologists immediately if they experience any of the following:

1. Intense pain that does not improve with medications 

2. A fever above 101 F 

3. Severe burning sensation while urinating 

4. Difficulty urinating 

5. Excessive haematuria (blood in the urine)

Delaying URSL can lead to several significant complications, particularly for individuals with problematic kidney or ureteral stones. Here are some common risks:

1. Stones left untreated can grow larger over time, making them more difficult to remove with less invasive procedures.

2. They can obstruct urine flow, leading to severe pain and increasing the risk of recurrent urinary tract infections. 

3. Untreated stones may cause significant pain, haematuria, or discomfort during urination, reducing the patient’s quality of life.

4. Long-term urinary obstruction due to stones can impair kidney function or cause permanent kidney damage.

Cost of URSL 

The ureteroscopy cost in India is subject to variation based on several factors. It generally starts at ₹ 50,000 and reaches ₹ 1,40,000. The average price of the surgery is ₹ 90,000. 

Note: This ursl surgery cost is approximate. Patients are advised to consult HexaHealth experts for the most current and accurate procedure expenses. 

Factors that affect the URSL surgery cost include: 

1. Type of Facility: Procedures performed in private hospitals cost more than those in government centres due to advanced facilities and specialised services. 

2. Geographical Location: Metropolitan cities and urban areas are costlier than smaller towns and rural regions due to cost of living and healthcare infrastructure differences. 

3. Surgeon’s Fees: Urologists with more experience or a strong reputation may charge higher fees. This can impact the overall expenditure of the procedure.

4. Stent Removal and Placement: A URSL with DJ stenting facilitates stone passage, which can add to the total cost. 

5. Insurance: The extent of insurance coverage helps determine out-of-pocket costs.

URSL full form is Ureteroscopic lithotripsy. It is a minimally invasive surgery that offers an effective solution for removing kidney and ureteral stones. It allows for the direct visualisation and fragmentation of stones. Due to its quick recovery period, doctors may recommend URSL for eligible patients. 

If you have been advised URSL, HexaHealth can be your best choice! Our network of experienced urologists ensures the procedure is performed with precision and care. We guide you through every step of the surgery, from diagnosis to postoperative care. Patients receive the highest quality of treatment for successful outcomes.

Suggested Reads

• Cystolithotripsy
• Urethrotomy
• Kidney Stone Laser Treatment