[Fish]

Originally Posted by WilliamTheIrish

For those of you who might have the choice next time, here is a highlight of the difference between the surgical procedure and lithotripsy:

Surgery:

Pre-op IV and probably some IV valium or other mild sedative. Most places have you see the surgeon in preop then off to the OR. Move onto surgical table. O2 via a mask, a little fentanyl, then a little propfol and your out. CRNA will insert an LMA (laryngeal mask airway) it's a less invasive type of intubation (supraglottic airway device) and allows removal before they reverse you to wake you up.

So, then you're put in stirrups in the lithotomy position. That's right. You're laying there like a bitch with knees bent over stirrups. Legs high in the air. Prepped with betadine or whatever cleanser is preferred by your surgeon.
After draping and gowning up, the surgeon will use a cystoscope (a scope about the diameter of your middle finger) and with some lube, go right into your urethra. That's right you candy asses, right up the dickhole.

Surgeon will look around the bladder, make sure you don't have any tumors growing and also make sure that after induction you didn't pass it. That happens a lot. Then find the Left or Right Ureteral Orifice (depending on which side youre stone is on.

Through that scope, surgeon will insert a wire into the UO, all the way through the length of the ureter and into the kidney. Sometimes the surgeon uses two wires. One for access or "working wire" and the other is a "safety wire" in case one wire manages to slip out of place.

After that the cystoscope is removed but the wires stay in place. To view the ureter a rigid ureteroscope is used. About 3mm in circumference the surgeon will thread thin wire through the ureteroscope and into the ureter all the way up the renal pelvis of the kidney. If you're stone is in the ureter, surgeon can try to remove it with a basket. If it's too large, surgeon will take a laser fiber and thread it into the scope all the way to where the stone is located. Laser is turned on and blasts of sound hit the stone fracturing it into smaller pieces. Sometimes the surgeon will "dust the stone", use longer pulses of sound to break down the stone into sand so there is not need to use a basket to remove pieces.

If the stone is in the kidney, the rigid scope comes out and a ureteral sheath (again about the circumference of drinking straw is lubed up and run through the urethra into the ureter and all the way to the renal pelvis. This allows the surgeon to effectively shield the ureter from any jagged pieces of the stone from tearing up the ureteral tissue. A flexible scope is then run up through the sheath and into the kidney. It can flex at the tip to look into all the calyces in the kidney and then the basket or laser fiber can be inserted for stone breakup and removal.

After the stone is removed a stent is placed. Ureters can become edemetous after surgery. Swelling up and not allowing passage of urine. Can lead to sepsis. Thats why you end up with a stent. Sometimes with a string attached (sometimes no string) and then it's wakeup time.

[chugs water profusely]