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 body’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 does  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.

308 Responses to Ureteroscopy

  1. Mary says:

    I never had kidney stones my whole life. Dec 2016 doc said my calcium vit d level was way too low. Gave me 50,000 mg once a week Vit D pills. Took for 2 months. Then on March 2017 I got my first kidney stone, intense pain, puking up yellow bile, couldn’t eat, sleep, just sat in chair hunched over for 2 days. Had bloody urine too which is what made me see urologist. Cat scan showed cyst on kidney, kidney stone in left kidney and another one stuck in ureter tube.?SP. Passed that stone in May. In the meantime, I had torn meniscus and had to have surgery July 17 2017. Passed two stones in grocery store bathroom day before surgery 7/16/17! Stones were long and size of rice and were calcium related. Two weeks ago got another kidney stone attack but not critical, no puking, just medium pain. Called urologist and I am having catscan done tomorrow 10/6/17 to see where stone is and how many more???? All these statements are making me very scared. I pray this stone is small and can pass on its own. Oh, and I have had bloody urine 4 out of 8 times a day peeing. That has been going on for over a month. The stone must be tearing me up! God bless us all!

  2. Karin Bentley says:

    this is why i am glad i live in Canada. i married a canadian. around july i got a a kidney stone. it took a bit for appointments but I finally got in. they lasered it and put in a stent. while i was waiting for surgery i got pain pills for the pain which was horrible. I paid nothing. I really feel sorry for all you folks that have to pay so damn much for medical, thats just so wrong. If i was still in the states i would have never been able to afford anything.

  3. Danny McMillan says:

    I had a rock as the Dr. described it since it was measured in cm. He said most are measuresd in mm. I had through the back surgery Friday and will get the tube removed in the morning. Very sore. Surgeon said it was about size of a quarter. In Hospital four days

  4. Pratik says:

    I have 12mm kidney stone. And I want to remove by laser operation. Please advise
    1. What is the cost of operation.
    2. And for how many days I need to stay in hospital?

  5. Kelly says:

    I went into hospital on the 27th of June with excruciating pain in my left kidney I was urinanating blod, vomiting and drifting in and out of consciousness. I had morphine and was put on a drip I then had a ct scan which revealed a 10mm stone blocking my tube and the liquid in my kidney had become poisonous. They said I’d have to have it removed throughout my back. The next day I went for surgery when I woke up the explained the stone had moved so they’d be able to do the laser treatment. They had put a stent in to widen my tube.(I’m 5ft and weigh 8st) I was in agony I’m still in pain often now but not as much. I’m still urinating blood most days I’ve had the poxy stent in for 9 WEEKS!!! I go in for my operation tomorrow, but I think I may have a water infection. Hopefully they’ll still be able to do the procedure.

    Oh I forgot to say while I was in they found out I had E. coli. I’m going to my doctors in a couple of hours to check for the infection.
    Who ever suggested the heat pack I’ve got one on it now it feels fantastic

  6. Laurie Graham says:

    Had the procedure today at Dartmouth Hitchcock in NH, and have to say many of these comments caused me more concern than necessary. Sure my throat is a bit sore as can happen with General Anesthesia, yes there is cranberry juice colored urine and some aching and twinging in my kidney. For those of you reading, you can have milder post-surgical experiences than experienced by some of the unfortunate folks here. My stone was 7mm x 5mm, which is why this procedure was necessary, as a stone this size could never pass on its own. I have had a stent in since July 20 as the stone appeared on a business trip and was blocking the passage of urine. I unfortunately became septic, so I had to wait until all infection was gone before scheduling the surgery to remove it. I was hospitalized for the sepsis in Charlotte NC as I had mentioned earlier, was on a business trip. Just want ppl to know. It everyone is unfortunate enough to have terrible pain, we are all built different I guess.

  7. Anil kumar says:

    sir this method remove my stone but after 7 days blood clot comes in my urine

  8. i terrible pain in my left back/flank area and had some nausea and vomiting in Feb. I passed it off as a stomach virus. Then about 3 days later, i could feel the pain migrating around my left side and down. I knew it was a stone. I started taking OTC Cytrex and drowning myself in Cranberry juice. On March 8, my urine was looking bloody and I felt like I had a 5 pound bag of flour sitting on top of my bladder. I can tolerate pain usually well and I never take narcotic pain killers. I don’t believe in it and ppl get hooked on narcotics and then move to heroin as a drug of choice. I’ve been using a natural supplement for chronic degenerative arthritis and herniated disk pain and it’s helping that.. When my urine turned bloody, I went to the urgent care clinic. I told the doctor I thought I was passing a kidney stone. I felt like I had to urinate 100 times a day and when I went to the BR, I would only dribble. I can feel my bladder going into spasms. That was what was so uncomfortable. The problem with a urinary blockage is the urine sits and stagnates. So I had a UTI. That doctor started me on Cipro for 5d and gave a sample of a bladder analgesic that turns your urine blue. I felt good for a few days, then right before my regular visit to my internal med MD, it flared up again, pain, nausea, vomiting, urinary frequency and urgency and 5 pounds sitting on top of my bladder. My internal med doc started me on Macrobid because I had staph bacteria showing up in my urine. I felt good for several days and started peeing buckets rather than dribbling. Then after the Sunday after Mother’s Day, I got sick in church, severe left flank pain where you have to grab your back. Felt like I had to pee buckets. I went running to the BR at church, could only dribble and the pain was unbearable in my back. I was recliner ridden all day Sunday. A heating pad to my back greatly relieved the pain and my husband had some Toradol on hand for the times he passed stones. I took 1 Toradol, got a little relief. The Toradol helped my arthritis pain. I took one more Toradol before going to bed, slept good and felt refreshed when I woke up on Monday. I got an apptment the next day with a urologist. He ordered a CAT scan which revealed a 9x5x5mm stone sitting at the UVJ, it stuck on top of my bladder. He said it can’t be blasted when it’s that low and recommends a cystoscopy to remove. I have a high deductible health plan. This will be costly and I already had to pay out of pocket for the CAT scan which was 1383$. The doctor started me on Flomax and I am light headed. I thought it was my imagination. I walked 3 miles at the track in the heat until I found out you shouldn’t be in the heat whle on Flomax. I haven’t seen any signs of a stone in my urine. I’m straining my urine every time I urinate, but not when I’m away from home. I guess it’s possible I could pass it in a public restroom without knowing since I don’t carry that strainer with me. I’m not in any pain right now. The CT scan also revealed a tiny lesion on one of my ovaries that I have to get checked out on Friday by ultrasound. The ultrasound has to be done transvaginal to see the ovaries. That’s going to be uncomfortable with a kidney stone causing pressure on my bladder. Can a stone 9x5x5 mm pass. the doctor says know. I don’t agree. If it traveled from my kidney down to my bladder, whey wouldn’t it travel the rest of the way down and out. Once they get in the bladder, most stones can flush out the rest of the way. The urethra where urine exits the bladder is bigger than the ureters that connect the kidney to the bladder . I read that the avg price of a cystoscope is $350-$3500. The surgeon said his bill would be approx $1000, that doesn’t include OP facility charges, and I’ll also be getting a bill from the radiologist that read the CAT scan. Kidney stones can bankrupt a person. There’s got to be a way to prevent them. I live in the kidney stone belt of the South. hard water causes them. Are there any agencies like the kidney foundation that can help ppl with the bills?

  9. PT says:

    I’ve recently completed this ordeal and have been thinking about leaving comments regarding my experience. I want you to keep in mind that this is a personal experience—it may very well vary depending on the person, gender, age, etc.
    Let me begin by saying that I had a kidney stone incident about 3 years ago. I experienced terrible pain in my right flank for about a week and was hospitalized but nothing ever came of it. I don’t believe I passed it but the pain lay dormant for a few years. My doctor told me this is not uncommon but I digress.
    In October of 2016, I started to notice my urine was getting dark and I felt very fatigued. I started going for X-rays and such and in November, they found that I had an 8.5 mm stone bouncing around in my right kidney. At some point, in December, it started to move into my ureter. The pain was excruciating once again so another round at the hospital and meds calmed it down. A few more attacks over the next few months and in February, I finally went for Lithotripsy shockwave therapy to try to break the stone up. It was only mildly successful but this experience was hardly a difficult one. I was put out and woke up an hour or so later in some mild discomfort but definitely manageable. Urinating hurt/burned for about two days. On my follow up visit, my specialist told me that he only managed to break a piece of it off and reduced the stone to about 6.5 mm. He wanted to try some other methods before resorting to a ureteroscopy and so we tried some other methods but in April I had another massive attack and was done with this thing. I went back in and told him to absolutely schedule me for surgery so as to remove this thing that was destroying my life.
    On Thursday, May 18, I finally went in for my ureteroscopy, nervous as all hell and not looking forward to it but with the knowledge that little else could be done to get rid of this constant pain and worry in my flank. Getting put under was an experience in and of itself—the way it is portrayed in TV and movie is quite accurate—you actually feel and hear and see everything slow to a crawl and then—OUT.
    I started to come out of it about an hour later in recover. My throat was killing me (breathing tube inserted must have scraped my insides), my mouth was VERY dry and it was incredibly hard to swallow. I remember having an immense need to urinate and the pain and burning was incredible. I told the nurse that I needed to pee or I would just piss the bed. She finally got a container for me to use and I pissed straight out blood. It was so disturbing but it did feel good to urinate though the pain and burning was next level. I was still in some shock so I remember breathing heavy and trying to get my surrounding.
    I had a stent put in as well so I had this thread hanging from my penis which every movement with it further brought on more burning and pain. Eventually, I was moved to another recovery room where I was given some juice (I can’t even describe how good it was to have some fluid down my throat—I was so parched). I urinated a few more times and was finally told I could go home.
    The next 3-4 days were horrendous. The amount of blood in my urine was very disturbing but even more so, the pain and burning was incredible. I almost broke into tears a few times because I was punching the wall in my bathroom so hard I thought I was going to break my hand. The drugs helped a bit but also constipated me which brought on another problem. It was absolutely hellish. After about 3 days, the pain started to subside but that stent was still causing me all kinds of grief.
    I finally had the stent removed yesterday (5 days after the procedure), which was another crazy experience. It felt like it would never end coming out—I felt like one of those magician props where the handkerchief continues to come out of a sleeve…funny now, but not so funny at the time. The good news is after about 10-20 seconds, that is over. It was almost instant relief though the rest of the day, I had kidney and bladder spasms which a little more pain med took care of.
    It is now the day after stent removal and I feel much better. I’m so happy I got this thing taken out but what an experience. My heart goes out to anyone who has to go through this. I did so much research on the net (though there really isn’t that much out there) but doing it first hand was another thing entirely.
    Good luck!

    • Kyle says:

      Exact same situation and experience. Had the surgery 3 days ago. Blood is gone. Urine is orange from medicine. Have the stent in till next friday when i need to get anothet lithotripsy. The pain after the uretoscopy wasnt terrible but was on meds too but the urinating for about 4 hours after was prob the worst hours of my life. Almost as bad as the pain in my testicles before surgery. Anyone been three days and my back and both kidneys are killing me. I had the surgery on left but both kidneys are bothering me. I know its a couple weeks of recovery but is this normal?

  10. Jim Nealis says:

    I had a ureteroscopy on Friday, May 5th – in both kidneys since I had 4 stones in one, 5 in the other. I was unconscious during the entire procedure, but awoke to discover I had a catheter that would be in me for three days, which was quite uncomfortable. I think it was because I have enlarged prostate problems, so Dr. thought it would help me urinate better, which it did. I had no pain whatsoever after the procedure. On Monday, May 8th, the catheter and ureter stents were removed. I felt great – but driving home from the removal, I felt a pain in my back (right kidney) area. It got so bad that when I reached my driveway I got out of my car and vomited. I had the oxycodone pills the Dr. had prescribed, still unopened on my table. I got one and pain slowly subsided after 45 mins. I contacted the Dr. – he said it was a typical post-stent removal spasm. I needed a mix of oxy and Ibuprofen the next few days. It is now May 15th – that pain is basically gone – but ten days after the procedure I still have lots of blood in my urine, which concerns me. Also, it still hurts a bit to urinate, thought probably due to my prostate. While the procedure went smoothly, the aftermath has been more than I expected.

  11. Stuey says:

    I’ve got to have this done soon, I am now really nervous as whilst the kidney stone pain has been excruciating, it seems it gets worse with the procedure from people’s experience ?

    • Jim Nealis says:

      No, the pain should be gone once the stone is removed. You will see a fair amount of blood in your urine for many days after the procedure. I did not have pain from the procedure – my pain came 3 days later when they removed the ureter stents. My right kidney/ureter had ‘spasms’ after the stent removal and I needed pain killers for a couple days to end that pain.

  12. Olivia Young says:

    I am 19 years old and I have just had this done on Friday 28th April, I had this to remove stones that trapped in my bladder passage I still have 6mm stones stuck in my kidney that will need further treatment. 2 years ago when I was 17 I had keyhole surgery to remove a kidney stone from my kidney called a staghorn calculus I had a stent placed in afterwards. The stent caused me numerous amount of pain and luckily this time I requested not to have one in and the surgeon didn’t need to put one in. I feel really poorly from this I am stuck in bed as I just have pain in my right side kidney and going to the toilet is so painful! I hope this is normal for a while? I am scared to go to the toilet! Does anyone know of any good painkillers or remedies that make you feel better? I am on ciprofloxacin antibiotics and I have just been given ibuprofen but these defiantly didn’t help my pain!

  13. I had this ureteroscopy done in Feb of 2017 for a three mm stone that was causing quite a lot of back. My lower back still hurts off on and the leg does too. Maybe they hit a nerve when they put the in I don’t know.

  14. Mary Ritchie says:

    This is a painful barbaric procedure. This so call small scope is inserted into your Urethra [hole you pee out]….Ohhh didn’t realize well, take a look at that so called ‘small’ camera. Surgery went seemingly well, then at home take Motrin, call Dr oh well thats why we gave you Oxicodone in case the pain intensified. Take the Oxi and Motrin. Every time you urinate its burning / painful and you go a great deal because of the stint. Three days with the stint and they lead you to believe it will all be over on day 3…Frig no! The stint comes out…they describe a small tube that allows the Ureter and surgical area to heal….they forget to tell you about the small coils holding it in place. Now with NO ANESTHESIA they place the scope back in your already tender urethra and remove the stint…as the coil uncoils and stint removed it creates further irritation. This ‘Irritation’ subsides in a day or so…. Well they omit telling you about the SEVERE cramping and pain like a horse has kicked your kidney that causes nausea and vomiting. Pain like you never had in life, Doctor just take the Motrin. Nausea, pain take Motrin now you vomit and that continues for hours until you end up in the ER……. Incision vs this torture…..INCISION!

    • Frank says:

      I agree but when they have to go through the back which is referred to as Perk you end up losing some overall kidney function. I had a uteroscopy last summer and the stent caused me so many blood clots that it literally caused a blockage in my urethra and I had to go to the ER. Worst experience of my life. Some resident who had never done this procedure before literally shoved a Foley catheter (the big ones) that was a few sizes too large in. He had to fight with it to get in. Now I have had catheters in and out my whole life… This was some next level shit. I was a grown man screaming in the ER. I went into shock and they gave me morphine 4 times which did NOTHING! to make matters worse, they weren’t able to get the stone out. Long story short the stone is actually stuck in the wall of the kidney. So here I am a year later about to go in for another surgery. This time though I’m at the Cleveland clinic which is suppose to be number 2 in the country when it comes to urology and nephrology. In any case if the dr can’t get it out on Monday than they will have to go through my back and open the kidney. It’s just scary because I only have the one kidney.

    • Bonnie says:

      Have you seen any stones pass? I’ve seen about 10 very small pieces of sand but was told I had a rock quarry in my left kidney so it’s been almost 2 weeks they took out the stent last Monday, just wondering where the stones are. I have to take pain medicine or I feel like someone is kicking me in my back left kidney?

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