• UPNT clinics will open at a delayed time at 10 AM on 11/11-23 Secondary to the ice storm. we will continue to update on the website as conditions may change.
  • UPNT clinics will open at a delayed time at 10 AM on 11/11-23 Secondary to the ice storm. we will continue to update on the website as conditions may change.
  • UPNT clinics will open at a delayed time at 10 AM on 11/11-23 Secondary to the ice storm. we will continue to update on the website as conditions may change.
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CULLS for Kidney Stones: Advanced Ureteroscopy with Laser Lithotripsy at UPNT

A Minimally Invasive Option for Large or Complex Kidney Stones in the DFW Area
At Urology Partners of North Texas (UPNT), we offer state-of-the-art kidney stone treatment, including CULLS, a highly effective, minimally invasive option for treating larger or more complex kidney stones. CULLS stands for:
  • Cystoscopy
  • Ureteroscopy
  • Laser Lithotripsy
  • Stent Placement
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Your UPNT surgeon may recommend CULLS for:
  • Larger stones in the ureter (> 1.5 cm)
  • Hard stones that don’t respond well to shock wave treatment (ESWL)
  • Stones in complex locations or those that require precision removal
CULLS allows your UPNT surgeon to access and break the stone into small fragments using advanced technology. Most patients recover quickly and resume normal activities within a few days.

CULLS vs. ESWL: Which Treatment is Right for You?

Both CULLS (ureteroscopy with laser lithotripsy) and ESWL (shock wave lithotripsy) are effective for kidney stones, but they are used in different situations based on the size and location of the stone.

When to Choose ESWL:

  • Stones in the Kidney or Smaller Stones in the Ureter (< 1.5 cm)
  • Non-invasive option with no incisions
  • Highly effective for stones < 1.5 cm in size

When to Choose CULLS:

  • Larger Ureteral Stones (> 1.5 cm) – ESWL is less effective for large ureteral stones.
  • Hard Stones – Stones that are resistant to shock waves can be pulverized with a laser.
  • Failed ESWL Treatment – CULLS is often the next step if ESWL doesn’t fully clear the stone.
  • Complex Stones – Stones in challenging locations or those requiring more precision benefit from CULLS.
Your UPNT surgeon will evaluate your stone’s size, location, and characteristics to recommend the best treatment option.

Step-by-Step Breakdown of CULLS

CULLS is a combination of several steps, each performed with precision by your UPNT surgeon to ensure complete removal of the stone.

Step 1

Cystoscopy

The first step is cystoscopy, which allows your UPNT surgeon to examine your urinary tract and access the stone.
  • A cystoscope (a thin tube with a camera) is gently inserted through the urethra and into the bladder.
  • This step helps confirm the stone’s location.

Step 2

Ureteroscopy

Once the stone’s location is confirmed, your UPNT surgeon performs ureteroscopy to reach the stone in the ureter or kidney.
  • A ureteroscope (a very thin, flexible scope) is passed through the bladder and into the ureter or kidney.
  • Real-time imaging ensures the stone is precisely targeted without damaging surrounding tissue.

Step 3

Laser Lithotripsy

Now it’s time to break the stone! Your UPNT surgeon uses a Holmium laser to pulverize the stone into tiny fragments.
  • Think of it like the classic arcade game Asteroids—the laser targets the stone and breaks it into smaller and smaller pieces until it’s completely fragmented.
  • Some fragments are removed immediately with a small basket, while others pass naturally over time.

Step 4

Stent Placement

Finally, a ureteral stent is placed to ensure proper drainage and prevent blockages as the stone fragments pass.
  • The stent is a temporary tube placed from the bladder to the kidney to keep the ureter open.
  • Most stents are removed within 1–3 weeks after the procedure.

Why Most Patients Need a Stent After CULLS

A ureteral stent plays a crucial role in preventing complications and ensuring smooth recovery after CULLS.

What Does a Ureteral Stent Do?

  • Keeps the Ureter Open: Prevents swelling or stone fragments from blocking the flow of urine.
  • Reduces Pain: Helps alleviate pressure in the kidney as fragments pass.
  • Ensures Proper Drainage: Promotes healing by allowing urine to flow freely.

How is the Stent Placed?

The stent is placed during the procedure using cystoscopy while you’re under anesthesia, so you won’t feel a thing.

Temporary and Easy to Remove

  • The stent is usually removed within 1–3 weeks.
  • Removal is a quick, outpatient procedure with minimal discomfort.

Recovery and Aftercare

Most patients recover quickly after CULLS. Here’s what to expect:
  • Mild Discomfort: You may experience some back pain, cramping, or blood in the urine for a few days.
  • Stent-Related Symptoms: Some patients feel urinary frequency or urgency while the stent is in place.
  • Hydration is Key: Drinking plenty of water helps flush out the stone fragments faster.
Your UPNT surgeon will provide personalized aftercare instructions to ensure a smooth recovery.

Frequently Asked Questions (FAQs) about Ureteroscopy with Laser Lithotripsy

Why is CULLS an alternative to ESWL or used after ESWL?
CULLS is often recommended as an alternative to ESWL for larger stones (> 1.5 cm) or hard stones that don’t break easily with shock waves. It may also be used after ESWL if the initial treatment didn’t fully clear the stone.
The procedure typically takes 30–60 minutes, depending on the size and location of the stone. Larger stones may take longer to treat, while smaller stones require less time.
You’ll be under general anesthesia during the procedure, so you won’t feel anything. Afterward, you may experience mild discomfort or cramping, which improves within a few days.
Most patients have a stent for 1–3 weeks. Your UPNT surgeon will remove it during a quick, outpatient procedure.
A Holmium laser delivers high-energy pulses to break the stone into tiny fragments. These fragments either pass naturally or are removed with a small basket.
Most patients return to normal activities within a few days. Your UPNT surgeon will provide personalized recovery instructions.
Still have questions?
Call our office today

Book an Appointment for Kidney Stone Treatment

At Urology Partners of North Texas, we offer advanced kidney stone treatment options like CULLS to ensure the best outcomes for our patients.
Conveniently located in Arlington and Fort Worth, we’re here to help you find relief from kidney stones.

Why Wait? Book Your Appointment Today!

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  • 5005 S. Cooper St. Suite 250 Arlington, TX 76017
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