Ureteroscopy

Diagram of ureteroscopy and laser lithotripsy

Ureteroscopy involves the use of a small flexible or rigid device called a ureteroscope to directly see and treat stones. The ureteroscope device, which provides a video image and has small “working” channels, is inserted into the bladder and up the ureter until the stone is encountered. The stone can then either be broken up with a laser fiber or pulled out using small baskets that are inserted into the working channels. The advantage of this type of surgery is that the bodyโ€™s normal openings are used and no incisions are necessary. A photo of a flexible ureteroscope and a video of ureteroscopy with laser lithotripsy is shown below.

Diagram of ureteroscopy and laser lithotripsy

Flexible ureteroscope treating a stone in a kidney

Ureteroscopy often a good option for small stones in the ureter or kidney. Its success rate at clearing these types of stones is generally higher than that for shockwave lithotripsy. Compared with shockwave lithotripsy however, it may associated with increased discomfort after surgery, especially when a stent is required. Ureteroscopy also doesย  not always work as well with very large stones, as the small size of the instrument makes it difficult to completely treat and remove such stones. In these cases a percutaneous approach may be preferable. For more information on comparing the surgical options for kidney stones, see our comparison chart.

 

Fast facts about ureteroscopy:

  • Typical operative time: 1 hour
  • Usual hospital stay: Usually none, ureteroscopy is outpatient surgery
  • Average number of days before going back to work: 8.5 days
  • Average number of days before feeling back to normal: 15.6 days

Data regarding return to work and recovery from a study by Pearle and colleagues, Journal of Urology, 2005.

Ureteroscope closeup photo

Photo of a ureteroscope next to a pen

 

Video of flexible ureteroscopy and holmium laser lithotripsy in a patient with multiple large uric acid stones.

253 Responses to Ureteroscopy

  1. diana says:

    Female.
    Mid 40s
    7MM stone close to ureter
    Removed it completely thru’ URS
    Stent for one week
    No pain during, after or at the time of removal of stent. IT was no brainer.
    Was in panic mode and completely petrified but it seems, reading reviews above, that female anatomy makes it easier? Not sure. I had no bad experience

  2. Dave says:

    I had a ureteroscopy two weeks ago on 10/18 and since this site and all the comments helped me prepare for it, I thought to share my own experience.

    I’m a 47 year old male. After enduring chronic abdominal pain for over two years and going through many tests related to gastro/digestion, it was discovered through a CT Scan that I had a 17mm x 7mm stone in my left kidney. The stone at 5mm had been seen in a previous scan a year earlier but my doctor brushed it off and said “you can pass that – let’s just watch it”, and the focus on the GI tract continued, despite me even starting to have typical kidney flank pain on my left side. Very frustrating, but even the urologist/surgeon who did the ureteroscopy didn’t think my abdominal pain was caused by or related to the stone in my kidney.

    By the time the surgery was scheduled, I was having daily gut, flank and back pain on my left side. The only thing that would help the pain was marijuana, and luckily here in Oregon it is now legal.

    The ureteroscopy was an “out patient” surgery, and as people in these comments say, it’s better to prepare to recover for it like you would for a regular surgery. Just being completely knocked out on general anesthesia is tough to bounce back from. For me, it took about 4 days to really want to get out of bed. Luckily my ureteroscopy went as planned. The stone was broken up and two large pieces had to be removed with a basket. A stent was placed. The first time I urinated after the surgery was awful and I experienced a LOT of pain while urinating and for about five minutes afterwards. The pain was in my lower left back, flank, pelvis and penis. Basically it was the whole route from kidney to exit. As others have indicated, having robust pain medication makes a difference. As a result of my pain, it was considered whether I should stay overnight. I ended up going home and that was the right call. Urinating for the next day was very painful, but I could tell it was reducing each time I went. The first night was rough though.

    Other than pain when urinating, I just felt crummy from the anesthesia, the drugs, the stent, and having things pushed and pulled through tight spaces. I slept as much as I could although I woke up having to urinate nearly every hour. I drank as much water as I could and while that made me urinate more, I think it helped. As time passed, the pain while urinating reduced to where it was more of just temporary discomfort in my lower left back. I found that sitting felt better than standing.

    As the haze of the surgery and pain pills wore off, the stent became more bothersome. In addition to making me feel like I constantly had to urinate, the tip of my penis hurt (or burned). I was glad to read online that this is common and starting take the over-the-counter Azo. It helped although it turns your urine bright red/orange, and it’s recommended that you only take it for 2 or 3 days in a row. I was also still taking Flomax (Tamsulosin .4 mg), Oxybutynin Chloride 5 mg (for relaxing bladder), and Trimethoprim 80mg.

    While the stent was scheduled to be in for 2 weeks, I persuaded the doctor to get it removed after one week by explaining how much it was bothering me. An X-ray was taken and we could see that some stone pieces were still in my kidney. The urologist thought it was several broken stones 1mm or less, and that they would pass once the stent was out. Having the stent removed was not fun. I asked for a sedative but it was not strong enough to make much difference. Getting the camera and grabber up into the bladder made me gasp and there was momentary pain. The stent was grabbed and pulling everything back out was equally uncomfortable and painful. The whole process took about 3 minutes, and I was very glad for it to be over. I was ok at first but about 45 minutes later the dull pain in my flank, pelvis, and penis became almost unbearable. I iced my groin, heated by back, took some pain pills, and then slept it off. When I awoke I felt much better.

    The next day I could tell having the stent out made a huge difference. I felt much more like myself again. I was still pretty tired though. I went back to work 6 days after the surgery but couldn’t last a full day the first few days back. It’s now a little over two weeks since the surgery. I feel really good and have no lingering effects. And the best news is that I haven’t had any abdominal, flank or back pain since the day after the stent came out.

    My goal now is to try to get the remaining stones passed. If some or all have passed already I don’t know it. After reading how effective roller coasters are at releasing stones in your kidney, I plan on hitting the local indoor waterpark and seeing if the water slides can do the trick. Also the stone I had was the typical calcium oxalate, and so I’m looking at diet choices to help reduce the chances of more stones.

    When I first read through all the comments here I got really concerned about doing the ureteroscopy and wondered if I’d be better off getting the percutaneous procedure. But with hindsight the ureteroscopy was likely the right one for me. Thanks to everyone for contributing to this site. It really helped me. Good luck to each of you!

  3. George-Whittaker says:

    35yr old male, Crohn’s disease since age 11!. Now crohns and. Stone development are linked I guess due too diet and certainly isn’t nice having both giving me troubles. Now I was complaining for a longtime from pain. Certainly listened. Too me in the end and found a 7mm ish stone ! Finally had lithotripsy which was great first time around then came the second blast which has made me feel awfull but no pain. Had a ct scan which did show the stone broke in two ! A piece in kidney and 1 in the tube which no pain whatsoever! I’m constant tired though, out off breath after a short gym sesh, feeling iychy and peeing bucket loads. Just had my pre op today and they shall be going down the jap within weeks too grab these bits! Now I’m not a big fan off hospitals however it’s gotta be done and ayy your a man shooting from it so be a man and have something shot up it lol best I trim and make things look pretty haa!

    Serious note: I’m just glad it was stone pain at the beginning and not something else from crohns! Certainly had woken me up even though I had a pretty good diet! A shot off Apple cider vinegar aday, grapefruit flesh, squeeze abit off lemon will do you wonders!

    I shall report back with an update as soon as I’ve woken and the nurses has stoppe taking selfies lol ๐Ÿ˜‰

    • George-Whittaker says:

      I’m in tomorrow folks 7:30am and I shall make an update as soon as I have come around from surgery! Abit shakey at first building up too my op day however I’ve got too the point where “carry on do as you please” still in no pain whatsoever even though I’ve a stone stuck. Maybe it’s because I’ve gone through the pain at first when seeking help and you just get used too it after a while! I’m in good hands I heard this surgeon is the best in southwales. Will update tomorrow ๐Ÿ˜‰

      • George-Whittaker says:

        Right I’m home from hospital for now! Surgeon couldn’t get through the tube and kidney area as was too narrow so a stent is in place which I’m feeling better with it in (suppose tube needs widening) the catheter was removed late last night very unpleasant feeling having it in, pulled out and the first urine passing well say no more however it does get better the more you go so I suggest getting the water down you! Now I’m booked in in roughly 5 weeks for the stent too be out hopefully I’d of passed the stones by then and doc can view my kidney that day! Hospital staff are great and liked after well!! Get some paracetamols in you too calm the discomfort while the stent is there but isn’t that bad afterall of you can tolerate passing and stuck stones you can handle a stent! It’s been nearly 12 hours since the catheter was out and in already passing clearer Urine than the first! I shall comment again next time I’m in and update my post. It isn’t as bad as people make it out and you’ll feel better from having it done! I haven t experienced any shortness breath since which is looking good ๐Ÿ˜‰

  4. Robert Hill says:

    It seems that questions and comments go unanswered by the owners of this forum. Bet they never even look in on it anymore.

    For those who want answers, this place the guy answers. May be the next day, but he does. Check it out!

    http://kidneystones.uchicago.edu/

    • Condy says:

      I have suffered for a month with a kidney stone. Several trips to ER and 5 CT scans. Every time sent home with pain meds and antibiotics. I was told should pass any day well today I had surgery the stone was wedged and laser was used , stent placed in for 7 days. I am bleeding and dread going to urinate because of the pain. Can someone please tell me how long this will last?

  5. Daniel Brewington says:

    I had a ureoscopy in Jan. they told me that i had four stones and it would take about an hour. I woke up almost four hours later and they told me I had over 10. Here it is 8 months later and I have passed three stones with two weeks with a horrible amount of pain. I am scared to use the restroom knowing that any second I could be going through the worst pain I ever felt

  6. Robert Hill says:

    8.5 days before going back to work? 16.5 before feeling normal. My doctor said nothing about limitations at all. I’m going back tomorrow, four days after the procedure.

    I wonder about one thing though. He mentioned something about scar tissue, but did not specify where. On Friday, the day after, I jacked one out, normal except I peed blood for several hours after.

    Today, Sunday the 11th, did the same, with the same results.

    Why would my urologist not mention abstaining from sexual activity if it is harmful to the recovery? He mentioned no limitations at all. Did he assume, that because I’m 55, I don’t do such things anymore? False assumption, I assure you. I do it at least twice in any given 24 hour period. Sometimes three times. Still feels the same at 55, as it did in my 20’s. Still the same amount at the end as well.

    If the scar tissue he mentioned is at, or around my prostate, and will prevent me from enjoying sexual release the rest of my days, I’m outta here soonest. I can live without a lot of things. That is not one of them.

  7. Robert Hill says:

    Well, tomorrow is the big day. Can’t wait! Right!! It’s got to be done. Got all the pre-op stuff done today. Sister is taking me and bringing me home. I’m assured that everyone who has undergone this at the facility I’m having it done at has had no pain issues at all. I’m told I won’t even know the stent is in there, except for having to sign a form acknowledging my knowing it’s there. ๐Ÿ˜‰

    • Piper Pierce says:

      I hate to say this but I just got home from having stone removed and I can barely breath I am hurting so badly. My doc forgot to leave a pain script and it is too late to get one. Thanks to the freaking drug addicts.

    • Toni says:

      lol ohdear, who told you the stent doesnt hurt must be on drugs or the biggest liar to walk the planet. Ive had mine in for three months, each step is like someone getting a knife in my bladder and stabbing me. At the moment, i have a fragment of a stone stuck and i cant even walk any more without tremendous pain. Roll on my next op and removal of stent!

  8. Robert Hill says:

    I have a 9mm stone stuck in my right ureter not too far from my kidney. Having this procedure done Thursday September 8th 2016. After all the reading, not looking forward to it one bit. But I really don’t have much choice, the stone has apparently been there since I felt the pain in mid July. When I tried to get an appointment with my urologist, I had to wait until August 30th, a frickin month and a half. I now have Severe Hydonephrosis, my kidney is all swollen up as is my ureter. Told I may end up losing the kidney, even after the procedure is done. They’re going to place a stent, which I don’t like. But my dad just had one removed, and he said it didn’t bother him the slightest. Hope it’s the same for me. But who the h-e-double-toothpicks knows.

  9. Yean Loon says:

    Pain in my left flank started 23rd July. Went to hospital and initial diagnosis was Renal Colic. X-rays proved inconclusive. Given painkillers and left. Follow-up appt 3 weeks later. Urologist asked a few questions and scheduled a CT scan in 5 weeks. And an appt with him 2 weeks later. All this while, not much pain, but on 2 occasions saw blood in urine.
    Decided to get a 2nd opinion.

    The 2nd urologist found a 6x3mm stone in my right ureter on the 20th Aug. It was weird cuz all my pain has been on the left side. Doc recommended surgery saying the area around the ureter was swollen and i probably won’t be able to pass out the stone by myself. Scheduled ureteroscopy on 25th and after the surgery, he couldn’t find the stone!

    Anyone has any thoughts?

  10. Janie Dotson says:

    I had 6mm stone removed July 26th, no stent thankfully, this is my 3rd stone removal. Went for my final recheck on 08/15/16, told doc I felt like I had uti, he said, no my urine was clear. 1:10 pm that day, I was passing blood and clots in my urine the size of dimes, with severe burning, painful, and frequent urination. Finally heard back from doc today, got script for ciproflaxin for possible infection, but they are stumped on the blood clots, thought maybe it was caused by my procedure 3 weeks ago. Any ideas?

  11. Mike Frost says:

    I had the Ureterostomy on 7/23 and without reservation, the worst pain I have ever felt time 10. I recommend that you stay one night at the hospital with an experienced staff in post Kidney stone pain management. I also had a tremendous amount of blood. After about 2 to 4 hour post op with the excruciating pain they placed a catheter. Oh what a relief, but still more blood, and then the pain came back. Not quite as bad but in continual spasms that I still rate at the 10 level. As I got through the night the pain went from 10 to 8 to 5 and still a lot of blood. I ended up staying two more nights to make sure there were no other complications and to manage the pain. I will have the stent removed in about eight days. I wonder if there are “old” fashioned type stents because I have read about the one you can remove yourself. Even though I hear some say it is easy and not overly painful, I am concerned.

  12. Rob Riddel says:

    Date: 7/24/16.
    I am a 55 year old male. I had a 6mm x 10mm stone removed 5 days ago with laser treatment and then they installed a stent. My procedure lasted 70 minutes. They sent me home with prescriptions (Morphine for pain), but it was so late to have them filled, the pharmacy where I lived was closed. So I relied on taking left over oxycodene pills I had from my ER visit a few days before the surgery. Big mistake. The pain I experience after the surgery was 5 times greater than the actual kidney stone pain. The burning during urination was so bad, I panicked every time I had to urinate. Today is day 5 and I feel fine. I have to have the stent removed in a week from now. I am not looking forward to that. Drink plenty of water. One thing I have to mention that helped me with the pain. The first night after my surgery was the worst ever. Up all night. I used heat patches on my back to alleviate the pain. It worked for me somewhat. I recommend trying these options because they worked for me. I downloaded an app on my cell phone that reminds me to drink a glass of water. Works great. Good luck all.

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