The ureters are tubes that carry urine from the kidneys to the bladder, and ureter pain is usually evidence of ureter blockage, perhaps because of a ureteral stone or some other disturbance requiring ureteroscopy (looking into the ureter) and the placement of a ureteral stent.
A pyelogram is a method of imaging the ureter (the tube that carries urine from the kidney to the bladder) most commonly performed during cystoscopy. X-rays are taken to identify a disturbance in the ureter and renal collecting system, such as stones, tumours, blood clots and structural abnormalities.
Ureteroscopy ± lithotripsy and stone fragment retrieval
If a patient has exhibited symptoms and signs of kidney stones, a computed tomography (CT) scan may be ordered to examine the upper urinary tract for stones. Once a stone is diagnosed it may need to be removed. This often involves the use of a ureteroscope (a long, thin tube with a camera attached to it) being passed through the urethra and bladder directly into the ureter. This instrument is highly valuable in the relief of kidney stones and the diagnosis of other kidney problems. The specific kidney stone removal procedure will vary from patient to patient, depending on the size and position of the stone. Usually the stone is retrieved with a stone basket. Sometimes the stone has to be fragmented with the help of a laser - this is called lithotripsy. Dr. Hayden will consult with you after reviewing the results of the CT scan to determine the best course of action for kidney stone removal.
Placement of JJ stent
A ureteral stent (also known as a kidney stent) is a thin tube inserted into the ureter to treat urinary problems caused by blockages of the flow of urine from the kidneys to the bladder. It is sometimes necessary to place a JJ stent in the kidney in preparation for the removal of kidney stones. The long, thin plastic tube is coiled at both ends to prevent it from slipping out of place, and stent placement is done under general anaesthetic and with the aid of an instrument called a cystoscope (a long thin tube with a camera attached to it) and X-rays. Placement of a JJ stent can also be advised in the cases where the patient is suffering from ureteral strictures or narrowing of the ureter that do not relate to kidney stones.
Tumour biopsy / barbotage ± brush cytology
A biopsy procedure is often necessary to test for the presence of tumours and cancer. Depending on the nature and location of the lesion, Dr. Hayden might perform a tissue biopsy in order to collect a small sample of material from the lesion (perhaps using a biopsy tweezer), so that it might be examined more closely in a laboratory. Barbotage cytology, which is the repeated injection and aspiration of a fluid into the area in order to obtain sample cells, can also be an effective means of diagnosis. Barbotage uses X-ray guidance and is particularly useful in the diagnosis of renal pelvis cancer. Another method of obtaining cells for laboratory examination is brush cytology. Here, Dr. Hayden will use a cytology brush to gently scrape cells from the suspicious area (such as in a Pap smear test). For rare bladder tumours such as urachal cancer, a multifaceted approach - perhaps using all of the above biopsy tests - will characterize the biopsy procedure.