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.

45 Responses to Ureteroscopy

  1. Debbie says:

    I have been passing stones for 35 years. I am usually able to pass them on my own with ibuprofen or tylenol. I had bil. lithotripsies about 9 years ago and all the stones were gone but one on the left. In 2010 I had blood in my urine and had a CT scan that showed multiple stones in both kidneys again. I opted to see if I could pass them. All but one are gone from the right. Three weeks ago I passed an 8x4mm stone from the right. Then I started having pain on the L and a lot of pressure. I had a 12mm stone in the L ureter. I think I could have passed it but my doctor freaked out and only gave me 3 days to try. So I had a stent (never had one in 35 years of passing stones) It was VERY uncomfortable at first. Not so bad now. The more acitve you are the more it will bother you. I went back to work 60 hours a week the next day. The stent pushed the stone back into the kidney. I have now had 2 lithotripsies and have passed very little of the stone. Now after 3 surgeries my doctor wants to do a ureteroscopy to remove the stones. Last measurement I still had a 9x8mm fragment. I am done!. The stent comes out tomorrow and I am going to see if I can’t pass the fragments before I have anything else done.

  2. Brandyshutt says:

    I had my procedure done today for the second time in 2 years. I plan on going back to work tomorrow morning.

  3. A jagtap says:

    I had the uteroscopy done about 7 days ago and a stint put in.
    how long it take to pass all fragments after operation ??

  4. Nandkumar JAgtap says:

    I had the urteroscopy done about 3 days ago and a stint put in.is it possible that kidney stone remains as it is after ureteroscopy

  5. Bill says:

    I had ureteroscopy with laser to treat a 5mm stone in my right ureter. I had a stent in for 5 days. Most of the time I feel good but once in a while I get some pain. My concern is that since removing the stent I have had clear urine, but 6 days after removing it there is intermittent blood again. Is this normal? If so how long does it usually take for this to clear up?

  6. ian.nihcaj@gmail.com says:

    Ureteroscopic Laser Lithotripsy is NOT the wonder cure it is sold as… a bit of research online quickly shows that for stones of 10mm or more (mine was 11mm), 58% (yes, that is NOT a typo – 58%) are left with stone fragments, whether or not that is the cause of my pain, I am waiting to find after a CT scan if this is the case for me, whether other complications are the cause I might be lucky if I ever find out however I suffer nearly as much pain as I suffered before the procedure, only now it is in a bigger area! Clearly the frequent cause of stones growing quickly again is because most of us are left with plenty of bits for them to form around again…. this is not something I was told, nor is it easy to find if you don’t know where to look! eg http://www.ncbi.nlm.nih.gov/pubmed/23083650

  7. Barbara says:

    I had a stone 12/25 (which I passed) and another one on1/16 which has not passed. When a CT scan was performed 12/25, I was told that I had at least 2 stones–one 4mm another the other 6 mm. Since it has been 8 days after the 1/16 stone episode, my urologist wants to do a ureteroscopy procedure. The urologist said that if I do pass the stone, then they will cancel the procedure. I am taking flomax in the hopes of passing it. At this point the pain goes and comes (but I use over the counter drugs to control the pain and I able to urinate. How long should I wait to see if I can pass the stone?

  8. Heather says:

    I had a ureterscopy with basket removal of two smaller stones and laser lithotripsy on one large stone. The procedure was done four days ago. The day after my procedure I was in so much pain the doctor told me to remove the stent myself. I did that but ended up in the ER from pain in my kidney a few hours later. The pain meds are not controlling my pain. My urine is red from the blood in it and I am still in excruciating pain. The only way I have been able to control my pain level is with morphine at the hospital and then taking a Percocet and Motrin 800 at the same time every 4 hours and a Percocet by itself in between. Is this all normal? Also I have not had a bowel movement for five days. I have been taking the stool softener, eating lots of fruit, I drank prune juice and even took a laxative. Nothing is working, could this be contributing to my pain levels? Please help!

    • Ladyintheloop says:

      I’ve been in your exact situation and was stuck there for 3 weeks before the doctor gave me something for bladder spasms. Apparenlty, the bladder spasms were causing me the most pain. Call your doc and ask for a script.

    • Kathy says:

      I find your story quite unbelievable! First of all, the stent isn’t situated in a manner in the bladder to where it could be removed without special instruments, ie. meaning surgical type tools. If you did in fact make the attempt to remove your stent, you must be Hudini! Second, seriously? No doctor would advise you to take the stent out yourself, really?

      • Dr. Mike Nguyen says:

        Stents can actually be self-removed by patients when a retrieval string is left in place. See our post on stent removal to see a picture of what this looks like. Only 12% of people responding to our survey on stent removal reported removing their own stents in this way, so we don’t blame you for being surprised about this (an additional 26% had their stents removed by having their doctor’s office pull on the string).

    • Jen Moore says:

      I had the same surgery for a tiny stone 4mm and was left with the exact pain you describe!! I was told that I have unuasally small ureters and the is edema on them and my kidney is swollen. It’s been difficult to pee without flomax but the side effects of flomax are almost unbareble….dizzi light headed and dry mouth! How long till I can pee normal again? When will the swelling subside? I am 8 days post op….

  9. silver says:

    my mother have a 1.1cm x 0.64 cm. kidney stone. And she’ll be undergoing the shockwave method. Would this method be a good choice for that size of kidney stone? Thanks. God bless

    • Dr. Mike Nguyen says:

      Shockwave lithotripsy is considered an equally good option to ureteroscopy by most urologists for a stone of this size. However, it has lower success rates than ureteroscopy. Ureteroscopy on the other hand is associated with increased discomfort.

      The American Urologic Association’s guidelines has this to say about ureteral stones 1cm or greater:

      For Patients Requiring Stone Removal (of ureteral stones 10mm or greater)

      Standard: A patient must be informed about the existing active treatment modalities, including the relative benefits and risks associated with each modality.

      Specifically, both SWL and URS should be discussed as initial treatment options for the majority of cases. Regardless of the availability of this equipment and physician experience, this discussion should include stone-free rates, anesthesia requirements, need for additional procedures, and associated complications. Patients should be informed that URS is associated with a better chance of becoming stone free with a single procedure, but has higher complication rates.

      Recommendation: For patients requiring stone removal, both SWL and URS are acceptable first-line treatments.

      You can read the full document here: AUA MANAGEMENT OF URETERAL CALCULI: EAU/AUA NEPHROLITHIASIS PANEL (2007)

  10. Diane H says:

    I had ureteroscopy with laser lithotripsy 4 days ago. They put in a stent. I am in severe discomfort with pain and pressure and the constant urge to urinate. I have quite a bit of blood and clots in my urine. Is the blood normal? I called my doctor and he said yes but it seems like quite a bit.

    • ana says:

      You need to ask your Doctor for Pyridim Vasicare to relieve the spasms, urgency,you should not be in that much discomfort. The longer you can keep the stent the better the healing process.

  11. Chuck says:

    I have a 1.45cm kidney stone that is trapped in a ureterocele within the side of my bladder. The ureter leading into the bladder is normal and nothing needs to be done beyond stretching the ureterocele and laser blasting the stone and basket removal of kidney stone debris. My urologist says he plans to use a stent run from my bladder all the way to my kidney which I have heard can cause great discomfort for several days. Why would a stent be necessary above the ureterocele within my bladder?

    • Dr. Mike Nguyen says:

      A stent is usually placed after ureterocele repair to make sure that the opening of the ureterocele stays open instead of just closing up again after being stretched open or incised open (cut).

  12. D. Crawford says:

    55 yr old male with 4mm stone, too near spine for shockwave treatment, must have Ureteroscopy; I am diabetic and have no insurance. What is average cost for this procedure? also Specialist says must come out, should not leave it in – Have others left stone — still hoping for it to pass??? What are consequences if not removed???

    • S Ford says:

      I had a 6mm stone in the ureter and was unable to have shock wave due they could not see on X ray because it was behind my pelvis. I told my doctor that I would rather be hit in the area with a sledge hammer than have another ureteroscopy. She said would you rather loose a kidney? after talking with her I scheduled it that day. I knew it would be worse case for me to loose a kidney but did not want to take a chance. I had a good bit of pain I believe from the procedure and the stent. It has been 5 days and still 6/10 pain half the time.

  13. Sara says:

    I just had this procedure done 2 weeks ago, and the stint removed 1 week ago. However, I feel like the pain is getting worse, and it hurts to urinate more than it did before my surgery. I’m already back at work too and it’s so hard having to wait on tables with this constant pain. Is this normal? ):

  14. Ronnie Johnson says:

    On September 6, 2013, I had a cystoscopy, ureteroscopy with holium lithotripsy, and a ureter stent placement. This was the fourth time I have had kidney stone surgery. It was my first time have a ureter stent placement. The stent made it excruciatingly painful to urinate. I did not think that I would survive the first night due to having to urinate frequently with accompanying pain. Also, I could not eat much for two days. I dreaded urinating for at least three days. I now (eight days later) have only slight discomfort when urinating, but my urine is still discolored indicating blood. I went to work 5 days after the surgery. I now know that that was too soon, especially given that the chief of my office kept me late two days even though she knew I was still recovering. I dread having the stent removed in my urologist’s office but at the same time I can’t wait to have it removed. Lastly, I had to wear adult diapers when I returned to work.- Ronnie

  15. Barbara says:

    I am a 56 year old woman who has had numerous stones and gravel over the past year and a half. Continuous kidney infections due to recurring stones. I have had 3 stents and 2 shockwave lithotripsy’s. I am going in on Friday for surgery on a 6mm stone caught in the urethra. I am having Cystoscopy, Retrograde Pyelogram, Uereteroscopic Laser Lithrotripsy, Ureteroscopic Stone Basket Extraction and Ureteral Stent Insertion. I am nervous about recovery time and how long it may actually take to feel back to normal. I have a demanding job and need to be realistic about returning to work. Can someone please shed some light on what I’m looking at here. Thanks :)

    • Lisa says:

      I just had the procedure done Thursday and I must say I am pleased. I had a 8 mm stone that was stuck approx 5 inches from entering my bladder. I came home that evening and plan on returning to work Sunday night for a shift in the ER (RN). I go Monday morning and have the stent removed. Unfortunately I have a 10 mm stone in my left kidney that will require intervention. This is my first time suffering with kidney stones and I can really empathize with my future patients. No worries and I hope everything goes well for you as it did me :)

      • randi says:

        I am so glad you are recovering so quickly = most of us take much longer. Can I ask, why is the stent coming out so quickly? I have had this done 4 times – 2 times when the stones were stuck in the ureters but all 4 times I had stents. The stents were in for 2 weeks for the non-obstructing stones and 3-4 weeks for the obstructing stones. I agree that 4 weeks is too long but can’t imagine your ureters being healed from having such a large stone stuck in there after only 3 days. One of my procedures, my finger accidently caught the string after 5 days and they said okay but that was a non-obstructing stone.

  16. Mandeep Singh says:

    I had surgery done yesterday, stone dust removed and a stent placed for better healing of the infection. But Today I am having unbearable pain while urinating. The pain is so unbearable, that I stop in the middle gasping for the pain to go away. The doctor says its normal. I am developing a phobia of peeing because of the severe pain. Any suggestions?

    • Susan says:

      Pour water on yourself while you pee. It helps for women, maybe for men?
      Take pain medicine – Toradol.
      Take OTC medicine to reduce bladder spasms – I forget what it’s called – ask your doctor or pharmacist.

      Good luck.

    • Adrian says:

      I recently paseed a 5mm stone. On the Friday night I got the feeling that it was close to coming out so I took strong prescription pain meds and compatible prescription anti-inflamatory supository. Amazingly, I got a good nights sleep. In the morning I needed a pee and knew what was coming! I had read that holding a hot wet flannel over ‘the end’ before peeing takes away a lot of the pain. It seemed to work. I used a (clean) flannel before and after peeing for the next two days and also kept going with the meds until I was sure I was sorted. I also used the flannel trick after I’d had an endoscope examination of my bladder.

    • randi says:

      it is too late now but in future ask for pyridium.

  17. Hein says:

    I just had a Ureteroscopy 3 days ago. My doctor gave me 2 days off, but today I attempted to return to campus, and I almost collapsed after barely getting out of thew car. Is the recovery time really on average supposed to be 8.5 days? And why on earth would my doctor just book me off for 2 days then :/

  18. David Howson says:

    I had laser ureterscopy recently on my kidney stones , however , the end of the ureterscope broke whilst in my kidney , has this happened to anyone else? I have been in dreadful pain ever since.

    • S Calvo says:

      My 17 year old daughter had lithotrispy and uteterscopy with holmium laser and stent placement yestersay. So far so good on pain scale c: The scope did break inside her. The docs flushed her kidney with water for 2 hours. They did tell me that if there are any particles left in her kidney it could cause…kidney stones in the future. This doesnt seem okay to me!

      • randi says:

        wow – I have had the procedure 4 times so far but never heard of the scope breaking. That is terrible. I do hope she is okay but the fragments the doctor is talking about is normal from any procedure. What they do is = take the laser and blast the stones in tiny microscopic pieces and then WE have to pass them over time but it is possible in the meantime for them to stick together and reform or just continue to grow back if you arent able to pass them. It depends on what part of the kidney they are in. I have had about a dozen stones the ones in the middle and top of the kidney are easy to pass once broken down but the ones in the bottom are against gravity and very difficult to pass and they are the ones that can grow back.

        You also want to have your urine sent to litholink.com they can analyse your urine to determine what is causing your stones so you can take preventative measures to stop them coming back. I have to take 1000mg of calcium citrate 3 times per day (must be citrate as calcium carbonate causes stones) – Magnesium citrate – 600mg 2 times per day with the calcium, Vitamin B6 – 100mg per day, Urocit K – 20MEQ per day (Potassium Citrate) and drink tons of water.

  19. Albert Chan says:

    Hi,

    I had rigid cystoscopy + laser surgery to remove the 1 cm stone in my urethra. There was no need for stent. It has been 4 days. I am feeling good but the discharged urine is very low. My doctor told me there is no need to drink liters of water so I am just drinking 7+8 glasses of water per day. Also, I am still having burning sensation while urinating although it has been 4 days. All normal?

    • randi says:

      the very little urine output is because you dont have a stent – that is why they put them in to prevent narrowing of the ureters after a scope has gone through. Cant imagine why any doctor would tell you to not drink alot as a kidney stone patient – it is absolutely necessary in preventing future stones

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  21. Chase says:

    Im a 26 yr old male going in for pre-op and surgery today. Im very nervous but with the amount of pain im already in, I cant wait to get it over with either. I have had stones before and passed up to a 6mm stone. At the moment one of my stones is as big as 10mm. Im wondering how much pain will I be in during the recovery/back to work period?

  22. Jennifer Rainey says:

    I had the uteroscopy done about 3 days ago and a stint put in. I am still seeing blood in my urine is that normal?

  23. Laura says:

    I noticed that the data from the chart is from 2005, would the recovery time still hold true today? Has there been any advancements that would help speed recovery time? I had shockwave lithotripsy done last month, last week they attempted the Percutaneous Nephrolithotripsy. They were unable to complete this. They informed me that the stone was to big and they couldn’t get around it, to block off the ureter. Now in a few weeks they will be attempting Ureteroscopy. They’ve said there will be at least 2 seperate Ureteroscopy surgerys. Do you know how long they have to wait in between? I have a 19.7mm stone, thats ruining my life! Is Ureteroscopy successful in such large stones?

    • rbb says:

      I was told that with stones that large they can only do the Percutaneous Nephrolithotomy – they make a small incision and basically vacuum them out. A stone of 19.7 mm cant safely be done via lithotripsy. From what I have been told, nothing more than 10 mm.

      • John says:

        @rbb – Not true. My wife just had a successful laser lithotripsy on a stone measuring 20mm (yes, that measurement is correct). The stone was lodged in her upper ureter. The scope was used to push the stone back into the kidney, then obliterated with the laser and the gravel flushed out. She’s actually going back to work tomorrow (the surgery was yesterday morning). Yes, she has some mild post-op pain and some discomfort from the stents, but she manages the pain with OTC pain meds and flomax helps with the stent discomfort.

  24. Paul says:

    Hello,
    I have a 4mm kidney stone that is still in my Kidney. Would this procedure be a good choice for that size? I am 25 years old with a big work schedule and I just want the thing gone.

    • Dr. Mike Nguyen says:

      Ureteroscopy has the highest success rate at removing small stones such as the 4mm one you describe. However, the recovery period with ureteroscopy tends to be longer than with shockwave lithotripsy. You can look at all the tradeoffs between these options further in our chart. A small stone can also be observed if it is not causing symptoms. Always talk to your local urologist to help make the best decision for you.

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