What is Endourology?

Endourology is a term that broadly refers to various medical procedures used to diagnose and treat the formation of calculi stones in the urinary system. These procedures are performed by an endourologist, a urologist skilled in the use of specialized exploratory instruments with which to examine the kidneys, bladder, urethra, and ureter. In fact, this branch of medicine is so-named because its prefix "endo" means "internal," while "uro" refers to urine and "ology" to the study of. Likewise, the names of the procedures used in endourology end in "scope" or "scopy," which translates to "view." So, with the aid of scopes, the endourologist is able to see inside the body and gain access with precision surgical instruments capable of removing renal obstructions 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 endourology closed procedures. This simply means the patient doesn’t go under the knife. In fact, most people who undergo endourology urologic surgery are treated on an outpatient basis and can usually resume normal activities relatively quickly. Not every patient is a candidate for these minimally invasive surgical procedures, however. For instance, total obstruction, strictures greater than 0.79 inches (2 cm), or the presence of infection are some of the circumstances that are considered contraindications.

One of the most common procedures in endourology is extracorporeal shock wave lithotripsy, which utilizes an imaging machine called a lithotriptor to target and break apart stones with projected shock waves. Once the stones have been shattered, the small pieces can safely be eliminated through urination. This procedure is limited to small stones, however. Another factor that may hinder success with this technique includes the location of the stones; stones positioned in certain regions of the kidney or bladder may resist being detected and targeted. Conversely, they may be successfully targeted, but the broken fragments may become trapped and cannot be passed through the 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. In addition, this procedure can sometimes make access to the kidney possible by using the ureters as a pathway. Other instruments used in conjunction with the ureteroscope to aid in the disintegration and removal of stones include impactors, graspers, lasers, and even tiny helical baskets in which to deposit and remove stone debris.

There are additional procedures used to target larger stones and those located in difficult areas, such as vesicolithotripsy and cystoscopy. The latter is particularly helpful in determining the cause of bleeding from the urinary tract. Percutaneous nephrolithotomy is a procedure that involves the use of needle catheters to deliver pneumatic pressure to break up stones. Unlike the other techniques described here, however, this procedure must be performed under general anesthesia.