Transurethral lithotomy (TUL) in Iran

What is TUL ?

Transurethral lithotomy is a common method by which a stone can be removed through a special telescope, or in special cases, a laser can be used to break the stone into very small portions. Transurethral lithotomy ( TUL ) is often performed for urinary stones.

In general, extracorporeal shock wave lithotripsy is suitable for upper or renal ureteral stones, but it is sometimes not suitable for dealing with middle or lower ureteral stones. In this situation, transurethral lithotomy is usually chosen for middle and lower ureteral stones that are not easily treatable by extracorporeal shock wave lithotripsy. Transurethral lithotomy procedure removes stones in the ureters. The doctor will use a thin scope to search for the stones and to remove stones. In this procedure there is no need for cutting in your skin. The scope will be passed through your urethra and then ureter to reach to your kidneys by your doctor. The doctor will use a small basket for small stones removal. The doctor passes a laser to remove or to break large stones and this procedure doesn’t need a long hospitalization.

Ureteral stones are associated with severe pain, nausea and vomiting and sometimes kidney obstruction and destruction in the short term, so decision making and treatment of ureteral stones is more urgent than kidney stones. 90% of stones less than 4 mm and 60% of 4-6 mm stones are spontaneously disposed of and can be given to the patient for spontaneous disposal of the stone for 2 to 4 weeks by medical treatments and fluid intake. If not released during this time, transurethral lithotomy should be done.

Stages of Transurethral lithotomy (TUL)

The transurethral lithotomy procedure is performed under anesthesia in the operating room. Depending on your stone and anatomy, it can take from 30 minute to 2 hours. TUL can be very simple or quite complex. In TUL procedure, at first the doctor has to look inside the bladder and insert a special stent through the urethra. It is best to take an X-ray before the procedure (fluoroscopy). Depending on where the stone is placed, a flexible urethra-scope is placed in your urethra.

Possible complications after inserting a urethra-scope include:

• Infection
• Narrowing of the urethra
• Bleeding

Transurethral lithotomy is a successful treatment for ureteral stones, especially inferior ureteral stones.

Who needs to undergo the transurethral lithotomy (TUL) ?

The most common symptom of ureter stone is a pain in the groin area, which is also a common symptom with a kidney stone. Therefore, for an accurate diagnosis, patients need to undergo careful diagnosis. Patients may also expriance other symptoms such as fever, chills, a limited amount of urinating, blood in urine, and nausea.

What can trigger the transurethral lithotomy (TUL) ?

The risk factor of getting transurethral lithotomy is higher for patients with a history of kidney stone (either the patient him/herself or the family). Moreover, other risk factors, such as obesity or dehydration, can also increase the probability of transurethral lithotomy. Calcium-based diseases that can increase the rate of calcium absorption, such as inflammatory bowel diseases, can also trigger the transurethral lithotomy. Additionally, following diets with high levels of glucose, protein or salt can result in transurethral lithotomy.

What are the tests confirming the necessity of transurethral lithotomy or TUL ?

Patients with associated symptoms need to pass several tests so that the medical team can confirm the origin and possible position of the stone. Usually, these tests consist of complete physical examination and the assessment of health history. Frequent tests for a transurethral lithotomy candidate include ultrasound of kidneys (to make sure symptoms are not due to kidney stones), abdominal X-ray, MRI scan of kidneys and abdomen, retrograde pyelogram and abdominal CT scan.

What are the factors to prevent the necessity of  transurethral lithotomy? Similar to kidney stones, the most critical factors to prevent the necessity of transurethral lithotomy is to avoid a severe reduction in producing urine per day (sometimes less than 1 liter). The latter can affect the entire organs, drastically.