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.

223 Responses to Ureteroscopy

  1. Danielle says:

    I have a question has anyone of you had to have a lithotripsy and a ureteroscopy Done in the same week which you were to have your menstral cycle? I was supposed to start by the 27th because í am taking progesterone which makes me have a period and it hasnt came yet and í was wondering if maybe my surgeries stopped it from coming on.

  2. JohnInNJ says:

    In 2015 I had 2 ESWL treatments and tolerated them fairly well. The hardest part was getting used to the stent, but by the morning of the 3rd day after the ESWL, I was ok.

    However a 6mm stone was left untouched and my urologist wanted me to get a laser treatment. I had the treatment 11:30 AM on 4/25/2016 and was told it would last about an hour and I could return home by 2PM.

    The procedure lasted over 90 minutes, I woke in tremendous pain and vomiting. When I finally got home at 7PM, I realized I was also incontinent because of the stent, according to the urologist. Plus he had told me the stnt would come out after 1 week, but now its 2 weeks.

    I detest using pain killers because they just seem to knock me out and when I re-awake, the pain is still there. But now I’m taking percoset and prescription strength ibuprofen.

    All in all, I would NEVER have this procedure again. I would use ESWL over and over until the stone was blasted than to endure the long lasting pain I have now. Downright barbaric.

    • JohnInNJ says:

      One week after the procedure, I ended up in the ER. I was unable to urinate any decent volume, what was coming out was blood and blood clots, and my bladder was over-filled. After waiting 6 hours for a urologist to show up, I had a catheter placed and bladder pumped. I had over 800cc’s of fluid removed from my bladder. I was given oxybutinyn by the surgeon to stop incontinence but was told by the ER urologist that this drug basically shut my bladder down. One week later, I had the stent removed and was told the incontinence would disappear – it hasn’t. I have to wonder what kind of damage was done to me by the laser lithotripsy.

    • Kate Ballew says:

      Amen! I had the procedure on May 9 and was told at my consultation that the stent would be uncomfortable and could be removed after 4-5 days, either at home by myself (string left for removal).or could come back for them to remove it. That might have been tolerable but after coming to in recovery, the Dr told me that I needed to keep the stent for at least a week, 2 would be great. Little did i know that would be the longest 2 weeks of my life! The receptionist called a few days later to schedule my follow up for removal, on May 27!! I insisted she get me in earlier, which ended up being the 24th. So..i have one day of hell with this stent. I can say that I will never subject myself to this torture again. I’ve had pain every day that the Percocets barely touched, I can’t stand for any length of time or I will pay dearly for it by night. Not to mention passing blood every time I try to pee and having a half full bladder at all times because I cannot empty my bladder no matter how hard I try. Calling the Dr twice gave me more antibiotics and anti-spasm meds, no additional pain meds for the last 4 days of my journey. Now I have the pain of removing the evil thing and recovering from that. I don’t know how horrible the other methods are in comparison (Dr claimed they are worse) but I cannot imagine anything worse… Ever.

  3. Sam says:

    I had laser lithotripsy 2 weeks ago and have had bright red blood and some clotting in my urine since and it is getting bloodier as the days go by, I can nearly stand up for long, I feel generally unwell went to ER and they told me to wait a week and go back to my scheduled appointment with urologist, I also have a burning sensation in my belly and chest also and they said it was not an emergency, I’m pretty scared as I also am clotting in my urine also, not sure if I’m being melodramatic or this is serious?

  4. JenC says:

    I got this surgery on Saturday and tried to go to work today (Tuesday). I could only stay a short time before I felt sick. I’m taking all of the meds and I do have a stent. I can’t get anyone to give me a decent number on how many days before returning to work. I know it’s different for everyone but the whole “next day normal activity ” isn’t working for me. Any time frame advice I can give my boss?

  5. Jim says:

    I am 71 and my first stone was 6 mm. After the intense ititial pain and vomiting with pain I had pain again on the second day after the emergency room diagnosis. It had not passed in 3 weeks so a ureteroscopy was scheduled. Piece of cake. A stent was put in place even though the stone was removed with a basket on the end of the roter rooter device. After surgery there was high level pain only for about 12 hours whenever I urinated. 48 hours after the surgery the pink urine is diminishing and only an occasional stab of pain when I have sat too long and the stent between my kidney and bladder “pokes” me. The stent will be removed at day #10 (mostly mental stress to come). Things went very easily compared to the experience reported above.
    I think the big difference was the basket removal. Reading other accounts was very stressing.

  6. CiCi says:

    Having passed and caught over 70 stones in my lifetime, and having hundreds removed using all the procedures and surgeries available (I have MSK born with the disease that produces stones), and just yesterday mad multiple removed via ureteroscopy with laser, I am lying in me bed with FOUR stents in! Yes, I have the misfortune of having 2 ureters on each side, sigh. The good news is that can pull them in two days. FYI I have suffered with stones since teen years, and am also a RN since 1978. I am 60 now.
    Tips
    1. Drink TONs of water as alleviates that sharp burning with urination. Using water is the best fluid for this.
    2. Take your Meds and don’t be a martyr during this time. It also a good idea to keep a notebook a scrap paper near your Meds to jot down the times you took, so easy to forget. Do not wait until the pain and discomfort become severe to take your pain Meds because they will not be as effective.
    3. Keeps crackers or something similar by bed to help alleviate nausea with the Meds.
    4. If on Flomax best to take it in the evening because many pesky side effects like blurred vision.
    5. My heating pad is also my lifesaver.
    Good luck and stay strong and don’t be humble during this time…..ask and accept any help that is offered. My strength gets zapped and very fatigued after the pain I endured for two weeks prior the surgery hoping I would pass them, and the post op fatigue.
    Many warm hugs…..oh, we cal all add our skill to our resume “excels at the production and implementation of kidney stone management” 😁

  7. Jim says:

    I am a 67 yr old male and had multiple kidney stones (6mm-7mm) removed from above the bladder 2 days ago, and had a stent put in. I have a constant urge to go and the pain of going is a #9 or #10, this cycles every 10-30 minutes so it doesn’t allow me much time to sleep between them.
    Urine is still a red color but it seems to be getting lighter. I suspect some of this pain is related to an enlarged prostate, but the Doc says nothing about it.
    Called the Doc about this and he thinks I should go back the the ER and have the catheter put back in. This is not something I would like to do, but if I don’t get any sleep tonight I might have to.
    Has anyone had a similar experience?

    Jim

    • margie says:

      my husband 57 years old had three kidney stones in left kidney. had liptripsy. did not work broke stone and got lodged in left kidney. then he had the one where they take a lazer tube in your penis and this time they got them all. however. 8 hours after he could not pee pain a 10 bladder stretched and would not let him pee. pain and blood went to emergency room. cather put in first day with it. a stent was put in after surgery was complere.

  8. Kodza says:

    Had ureterorenoscopy 7 days ago, indweling stent and catheter removed after 5 days post op,heavy bleeding due to false passage at ureter- bladder entry,no more stone but stil clots and urine colour of beer and occasionaly bloody urine.Generaly no pain except burning feeling on urination at point of injury. Dr is no specific about recovery time,for him bleeding is normal,check after 2 weeks prescribed antibiotics.as i can see fm forum members what is written about recovery time at hospitals and reality recovery time differs.in my case i saw one panelber state se issue and 8 weeks ureter to heal so any similar experience about blood in urine and recovery time will preciate,thanks!

  9. Jason says:

    Please give me a hospital that has this procedure and anymore information. Thanks

  10. Sam says:

    I was feeling small pain from time to time in right side of abdomen for 3 months when i did cat scane find out its kidey stone of 1 cm.
    Doctor decided to do shock wave lithotripsy and put stente between kidney and blader.
    I did some readeach and find out that the purpose if the stente is to protect the kidney by passing the urine in case of dtones block the ureter. The huge pain gotten from the stone is not realy the stone itself but the pain comes when the stine block the ureter and urine put pressure on kidney. So when this happen and when having the stente the urine go through the stente. The stones when they pass they pass between the stente and the ureter. They have to be small enough to pass . There is no way to go through the stente as it is rounded it make a circle in its ends and its diameter is around 2 mm too small.
    After 1 week i did xray and find out there is 4 mm stone left. Doctor decided to do laser lithotripsy and remived the stente. Stones passed next day it was 6 stones of 2 mm each.
    I start feeling achy pain around kidney i thought that still others stone left. But i think this small pain is from the pricedure . I read some posts herecsaying that this pain will go away after 1 to 2 months . I hope that this is true.

  11. Kstone says:

    So 2 weeks ago I was in the ER with my first 6mm stone.
    The first day was horrible but now the pain is surprisingly beatable. At my follow-up today it has moved a lot but still in my uereter. The doc said we could wait or he could take care of it Friday with ureteroscopy & laser.
    I plan on traveling next week. I could get it done & not worry about it. He said recovery should be 1-2 days and no stent should be needed.
    Or risk more pain next week.
    Any thoughts? Wait it out or get er done?

    • Hazza says:

      I’m just out of hospital today after having 5mm stone blasted by laser yesterday. I’m still in pain, urine is bright red. I also have a stent in. ThinkI think it will definitely take more than 1-2 days before recovery, I would say 1-2 weeks is more accurate.

  12. Michele says:

    I’m postoperative just a day from having a ureteroscope and stent placed.. I in a lot of pain in my kidneys I’m unable to sit because it’s so much pain not sure if it’s latter spasms or what’s going on.. I get the stint out in 5 days.. Anyone that can not sit down? Even when I go to the bathroom I have these sharp pains from my growing in to my back for as along as I’m sitting it’s pretty unbariable.. They told me I’d feel so much better but I’m so sore it’s crazy

    • Bumper says:

      I am two days post operative and it hurts like hell to sit down on the loo in spite of taking pain meds. How long did it take for your pain to ease?

    • Debbie says:

      I just had stent removed after two weeks. I was uncomfortable the whole time and would have kidney pain with headaches and hot and cold sweats but not the pain you explain. If unbearable even with medication I would get checked. Hope you feel better soon!

      • Katrena Scott says:

        I had laser surgery 3 days ago and a Stent put in the pain is at times unbearable. I can’t sit it feels like I am urinating razor blades I am passing stone fragments every bathroom trip which is very often and believe me it is dreaded. I have pain in the lower area and in my vagina. I am wondering now if I made the right choice, I also don’t think the pain meds are strong enough for the pain.. This is horrible. I may be a wimp also!

  13. Elizabeth says:

    I was supposed to have lithotripsy, sonic wave treatment. The stone moved and I had the ureteroscope procedure. My stone was 5 mm, elongated and attached pretty well to something! I had outpatient surgery. The doctor was great and was able to remove the stone with this procedure. He put in a stent. I usually have no problems with surgery or anesthesia. I ended up going home and vomiting all night which meant I couldn’t keep pain meds down. I ended up back at the hospital for dehydration. I spent 1 night at the hospital and had an IV. We changed a few meds too. Getting meds intravenously bypasses your stomach and that really helped. My back and side really hurt. I haven’t had pain when voiding. I went to my chiropractor and that helped a lot because your body gets very misaligned from surgery including your jaw due to the tubes they put in your throat. Chiropractic helped with the post surgery headache too. I will be returning to work one week after surgery which is honestly too soon but I missed a week before surgery and feel I need to get back to my students. Definitely glad I didn’t try to pass this on my own though.

  14. Peter says:

    I have a 1.3cm stone sitting in the kidney and blocking the ureter. My doctor think this is causing my kidney function abnormal(creatine 1.46). Anyone has this similar experience, stone causing kidney function to be abnormal? Thanks.

    • Tiffany says:

      I had a 9mm stone blocking the entrance into my ureter. Urine was backing up into my kidney and it was getting swollen. I was supposed to have ureteroscopy on wed, but the pain started getting really bad, so I called my dr’s answering service and he met me at our hospital yesterday (Sunday) and took it out.

  15. Danielle says:

    I am a 31 year old female suffering from kidney stones. I have a horseshoe kidney which is inverted slightly on both sides and slows the flow on my right ureter. I was admitted to the ER back in September for a severe kidney infection and pneumonia. It turns out I had many large stones in both kidneys. They placed stents on both sides and when I was discharged over a week later, I was back in to have my first procedure…ureteroscopy with lithotripsy laser. they wanted to perform a percutaneous nephrolithotomy but said it was too risky for my kidneys since I essentially am working with one big kidney since they are joined.
    On my left I had a stone that measured 1.5 centimeters, not millimeters, and then many others a bit smaller than that.
    The giant stone was on my right side. It was almost the size of my kidney! How does that even happen? After the ureteroscopy was fone on that side, they told me it measured over 4.5 centimeters!! Again, not millimeters.
    I have had three ureteroscopies in 3 months. They worked on my left side the first time, my right side the second time, and bilateral the third time which was this past December. When they worked on my left side alone, my ureter tore because I had too many stones embedded that they had tried to extract. It was agony for days. Regular work resumed about a week later and then 3 weeks later I had the next procedure. Bilateral within 6 weeks from there. My stents were put in place when I was hospitalized for the kidney infection and I just finally got them out last week. Obviously, they were exchanged during each procedure as to not calcify. I went to have them removed permanently last week but the x-rays that were taken just before shows that I have large stones in my left kidney and many fairly decent sized pieces hanging out in my right side still. I have to get a renal scan and abdominal ultrasound on the 26th of this month to determine the full size of my left kidney stones. The doctor is hoping we can just do shockwave but based on how everything has gone, he fears I may have to have ureteroscopy again. Is there anybody that has had both of these? I am curious what the recovery is from shockwave and is there much pain associated with that treatment?

    • Sam says:

      I think theyvuse shoke wavevfor bigger stones 1 cm and more and laser lithotripsy for smaller stones couples of mm
      I think the laser one is easier than the shoke waves. From my experience i had pain only in the day of the surgery.
      Putting stente will give small pain when urinating in first days then get used to it

  16. James says:

    I had a ureteroscopy procedure performed 13 days ago, no stent required, however I am still feeling discomfort in the bladder and urethra area, it’s like my bladder isn’t emptying completely, this showed on the bladder scans post op, I am also noticing the amount of urine I void has decreased.

    I am thinking of contacting the hospital to let them know, especially as I was diagnosed as having trigonitis about 9 years ago, and the procedure may have inflammed the trigone bladder area again.

    The hospital did say the laser ablation of stones in the ureter had been successful, in fact I have passed some stones about a week after the ureteroscopy.

    I just wondered if anyone else has experienced this issue?

    • Emily says:

      I’m 7 days post op (Ureteroscopy with laser lithrotripsy and no stent) and Im still having major ureter aches and burning with urination. I would’ve thought the ureter swelling would’ve gone down by now but this is definitely better than the stone pain.

  17. Courtney says:

    Hi All,

    I am a 32 year old female and started getting stones about 5 years ago. I would get a few a year but never found a urologist I liked until just recently. 3 months ago I went to the hospital for pain in my lower left abdomen. It turned out I had an ovarian cyst that had burst. When they did the ct scan the doctor also asked me if I was having any pain on my right flank because I had a stone. He didn’t express any concern about it so I never worried and thought I would pass it like I did the rest of the ones I’ve had. Well this past weekend I had severe pain in my right side. Due to the demands of my work schedule I spent the weekend in agony and finally made it to the urologist today. It turns out the stone is over 1cm and is almost completely blocking my ureter. He is performing a ureteroscopy with lithotripsy and a stent placement on this Tuesday. What is the recovery time like after this?? I work retail management and everything I have seen is mixed some say 1-2 days, some say a week to 9 days. I’m so nervous!! Any help you guys could give me would be highly appreciated!!

    Courtney

  18. Jess says:

    I am a 29 yr old female and had multiple kidney stones (3mm-5mm) removed from both kidneys 4 days ago, followed by a stent from right kidney to bladder (luckily I only needed one stent!) I just wanted to share my experience to offer some sort of comfort/relief. Honestly, so far the worst part of the whole process has been my anxiety leading up to the surgery. I was so nervous and anxious about the pain that I freaked out on my doctor before surgery – he gave me some valium to calm me down which definitely helped! Yes, the stent is uncomfortable and I am looking forward to having it removed in 2 days, however, it really isn’t as bad as my imagination has worked it up to be. I have slight back pain and every now and then I get a throbbing cramping feeling in my abdomen, but I take the meds my doctor prescribed and have found that a heating pad and ice pack help calm the area. Even urinating isn’t as bad as I thought. I just drink tons of fluids and stay really hydrated so that when I get the feeling to pee I actually have to pee and it’s not just the feeling. I know everyone’s experiences are different but for those who are really nervous/anxious about it, I want you to have that hope that not all scenarios are awful.

    • Marion says:

      Thank you so much for sharing this.i have had a 5mm stone stuck in my lower ureter and It has been there 6 months as I am terrified of the procedure.you have just made me feel much better thank you.

    • Mrs. Kaushik says:

      Thank you so much. My husband has 10mm stone in ureter and multiple stones in kidney for which doctor has suggested for stents as well. I am really anxious imagining how the pain of stents would be. It is really freaking me out. However, your experience has really given me some hope that I am praying he comes out of the surgery really well and those “stent” do not pain him as they sound to be.

  19. Nicholas Scott says:

    I had sure very about 7 hours ago and stent put in. I’ve been pudding razor blades since. Color is slowing getting clearer but literally scared to drink water because of how bad it hurts to uribate. Anyone eske have this problem and did it last long?

    • Janita says:

      Yes having it now. But another thing I noticed not getting any fragments out. And continuing to drink 70-90 oz of water today my cysto and lithotripsy was done 1-6-16. 3000 shocks hitting 4 size range 8-9 mm. This pain is horrible but noticing tonight losing control of my urine and having to wear a depend so I don’t wet myself trying to make it to the bathroom. One minute it ok next your cursing as you try to stand up and walk to bathroom the. Before you can sit it comes dribbling out. SUCKS

    • Roy says:

      Had ureteroscopy done 4days ago, still have stent in .You have to drink lots of water to clean kidney or you could get infection. It will clear and less burning each day.

  20. Carrie says:

    GAH! This brings back all nightmares!!! The stent portion is the WORST. I was in post-op for HOURS on Valium and morphine because of it. I threw up on my way down to the car at discharge. I threw up NUMEROUS times during the following 7 days with it and I was down FLAT. When I moved, the stent moved. Felt EVERY.SINGLE.TWITCH it made. Ended up in the ER on day 2 with it…it was THAT bad (and I had two babies and couldn’t hack this!).

    Before removal, I took anti nausea med. they yanked that bad boy out, I got light headed, very warm and sweaty, delirious, and ended up sprawled out on the doc bathroom floor (nice cool tiled floor!) dry heaving.

    Now a year later, either that procedure didn’t work or I have new stones. Shockwaves didn’t work (again) and here I am in panic mode. I’m almost thinking a full incision into the kidney is better. Just a sore, stitches/staples and not some foreign plastic thing stuck in places it doesn’t belong! Even gallbladder removal was easier than this BS stent thing! LOL

    Yes. Cheese with the whine, please.

    • Danielle says:

      LMAO over here because I relate!!

      I was hospitalized for a week with a terrible kidney infection (for my unique horseshoe kidney, that means danger) and the evening of the day I was discharged, I had a massive stone trying to pass (we had planned for ureteroscopy in two weeks time) so I was back in the next day. Found a 1.5 CM, not mm, stone in my left with many right behind it and a 3.5 CM stone (later found out it was over 4CM big) stone on the right. Because of the anatomy of my kidney, the doctors said it was too risky to go in through my back. Three ureteroscopies later (and one torn ureter tube that had 8 weeks to heal) I am back in this week for my bi-lateral procedure to hopefully end this saga! These stones have been monsters and the nausea, pain, discomfort, infections are well past their welcomed (which was never) time.

      I hope they don’t return though I was told it is highly likely stones will form again. The pain was worse than giving birth to my daughter for sure!

  21. Chris says:

    It took me about a week to feel fine after the stent was pulled on my surgery. I needed 2 procedures to get my stone lasered out of me. First surgery was to put a stent in because the ureter wasn’t wide enough. The second procedure she lasered the stone and a couple weeks later, stent removal. That was 6 months ago . I know I don’t have a stone in the kidney, but I still have this dull ache that last a hour a couple times a day. I asked my urologist about it and she said that she doesn’t know what it is and she has heard other patients say the same thing. I just shook my head when she told me that.

    • Anjum says:

      Same thing happen to me. I had this dj stent in my left uretor for 20 days and then urologist planned to remove after ct scan on 9 november 2015s. After removal i remained ok for 5 days then I started having pain on the same side of stent .i did ultrasound which was satisfied. Since then very often i am feeling this pain which lasts mainly for 3 to 4 hrs continuesly and this pain is mild to moderate in intensity. I talked to my urologist he told this will remain there for 1 to 2 months .its because of stone itself and stent and also because of uretheral dilatation. So these days i am feeling it and waiting for time to go.

  22. Mb says:

    Here is a question I can’t find the answer to. I’ve read all the comments but no one has said how long it takes to feel normal again after stent has been removed. I’ve felt sore/achy in the kidney area and I’m 4 days post stent removal. Can someone please tell me if they were sore in the kidney area and how long it took to be back to normal!! Thanks in advance!

    • JH says:

      MB,
      I assume you had a ureteroscopy for removal of a stone and a stent placed. I have had this procedure a few times–getting ready for another one which is how I found this site. The first time I had the procedure I recovered (felt normal) within a week. However, after the most recent procedure (two years ago, 55 yrs old) the recovery was much longer. My kidney felt achy off and on for 2-3.months. Alcohol consumption aggravated the kidney–so I stopped alcohol consumption for several weeks. Anyway, I assume that the location of the stone, its size and trauma of the surgery are all factors in recovery time.

      • Ephy says:

        I had the procedure done 2 days ago. I am having on and off pain on the side were it was done. Not as bad as kidney stone pain but discomfort. It seems to last for about an hour or so, but then disappears for many hours. How long can I expect to have pain for? I also have blood in my urine. At what point if any should I be worried.

        • Ephy says:

          I forget to add, I didn’t have a stent put in.

          • Chris says:

            It took me about a week to feel fine after the stent was pulled on my surgery. I needed 2 procedures to get my stone lasered out of me. First surgery was to put a stent in because the ureter wasn’t wide enough. The second procedure she lasered the stone and a couple weeks later, stent removal. That was 6 months ago . I know I don’t have a stone in the kidney, but I still have this dull ache that last a hour a couple times a day. I asked my urologist about it and she said that she doesn’t know what it is and she has heard other patients say the same thing. I just shook my head when she told me that.

        • Roy says:

          Ephy your lucky if you didn’t have a stent put in, the blood in urine will clear up in about 4or5 days, drink lots of water. Pain will lessen in a week or two hopefully .

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