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.
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.
Ureteral stones are usually associated with symptoms such as severe pain, vomiting, nausea, and in rare cases, urinary obstruction and kidney destruction. Thus, coming up with a robust treatment in a short time is more critical for ureteral stones rather than kidney stones. Transurethral lithotomy (TUL) is a procedure during which doctors remove stones in ureters.
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.
A urethra-scope is a special and very thin device used for direct visualization of the urethra. Some urethra-scopes are flexible like a long straw and some are more rigid.
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.
What to do after transurethral lithotomy?
- Drink 2 to 4 glasses of liquids in a day. If you have no limitation, suggested by your doctor.
- Avoid strenuous activities.
- There is no prohibition on walking and climbing stairs.
- There is no prohibition on sex.
- slightly bloody urine is common
- Avoid heavy exercise, skipping and jumping.
- In case of fever or severe blood in the urine, the patient should see a doctor or hospital emergency as soon as possible.
- Taking aspirin, warfarin, Plavix, indomethacin, diclofenac and brofen is allowed only with the doctor prescription
TUL (transurethral lithotomy) FAQ
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.
Is the type of water or region in which patients live increases the probability of transurethral lithotomy or TUL ?
Despite the overall belief, there is no clear correlation between the type or quality of water that patients take and the probability of kidney or ureter stone or necessity of TUL. In other words, boiling water or taking mineral water do not decrease or increase the likelihood of TUL occurrence.
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 is the most common type of kidney stones and ureteral stones?
The most common type of kidney stones and ureteral stones is a calcium type. Decreasing the consumption of oxalate-rich foods, such as spinach, peanuts, beets, tomato, potato chips, and chocolate, can reduce the risk of developing calcium-type kidney stones.
Moreover, treatments such as chemotherapy can result in the development of uric acid type stones, which is more probable for those who have a purine-rich diet. Purine can be found in meats, fish, and shellfishes.
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.
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TebMedTourism Company is an International healthcare facilitator based in Tehran, Iran.
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You may also like to do Transurethral lithotomy (TUL) in other cities in Iran:
- Transurethral lithotomy (TUL) in Kish
- Transurethral lithotomy (TUL) in Sari
- Transurethral lithotomy (TUL) in Urmia
- Transurethral lithotomy (TUL) in Yazd
- Transurethral lithotomy (TUL) in Esfahan
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