Endourology is a minimally invasive medical procedure that uses specialized instruments to diagnose and treat stone formation in the urinary system. Procedures include extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. Most patients can resume normal activities quickly, but not all are candidates for these procedures.
Endourology is a term that broadly refers to various medical procedures used to diagnose and treat stone formation in the urinary system. These procedures are performed by an endourologist, a urologist skilled in using specialized exploratory instruments to examine the kidneys, bladder, urethra, and ureter. In fact, this branch of medicine is so called because its prefix “endo” means “internal”, while “uro” refers to urine and “ologia” to the study of. Similarly, the names of procedures used in endourology end in “scope” or “scopy”, which translates to “view”. Then, with the help of endoscopes, the endourologist is able to see inside the body and access it with precision surgical tools that can remove blockages in the kidneys without making any incisions.
Most of these procedures do not require open surgery under general anesthesia in a traditional operating room, so they are referred to as closed endourology procedures. This simply means that the patient does not go under the knife. In fact, most people who undergo endourological urological surgery are treated on an outpatient basis and can usually resume normal activities relatively quickly. However, not all patients are candidates for these minimally invasive surgical procedures. For example, total obstruction, strictures greater than 0.79 inch (2 cm), or the presence of infection are some of the circumstances considered contraindications.
One of the most common procedures in endourology is extracorporeal shock wave lithotripsy, which uses an imaging machine called a lithotriptor to target and break up stones with projected shock waves. Once the stones have been broken up, the small pieces can be safely eliminated through urination. However, this procedure is limited to small stones. Another factor that can hinder success with this technique includes the location of the stones; stones placed in certain regions of the kidney or bladder may resist detection and targeting. Conversely, they can be successfully targeted, but the broken fragments can become trapped and cannot be passed through urine.
Ureteroscopy is another endourological procedure that can address the above concerns, as well as stones that have been lodged in the ureter for any length of time. Also, this procedure can sometimes make it possible to access the kidney using the ureters as a route. Other instruments used in conjunction with the ureteroscope to aid in stone disintegration and removal include impactors, forceps, lasers, and even tiny helical baskets in which stone debris is deposited and removed.
There are additional procedures used to target larger stones and those located in difficult areas, such as vesicolitotripsy and cystoscopy. The latter is especially useful for determining the cause of bleeding from the urinary tract. Percutaneous nephrolithotomy is a procedure that uses needle catheters to provide pneumatic pressure to break up stones. Unlike the other techniques described here, however, this procedure must be performed under general anesthesia.
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