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.

83 Responses to Ureteroscopy

  1. Michael says:

    I had a 10mm (1cm) stone in my right kidney at the kidney/ureter junction for 2 months before I had a Ureteroscopy laser oblation and a renal stent. Both causing me tremendous amount of pain in my right side and back. The stent was removed after my surgery and I was told to take Ural (product in Australia) which is a soluble solution you put into water which reduces the acidity of the urine to relieve some of the stinging and burning sensation I experienced during urination and to my relief it did provide enough relief to reduce my pain from urinating razor blades (yes that is how it felt) to a moderate pain which was much more tolerable. It has now been about 3.5 weeks since my Ureteroscopy laser oblation surgery and 2 weeks since my stent removal and I am still in a moderate, sometimes high-moderate pain in both kidneys (despite only having stones in my right kidney and a CT only days ago confirming NO stones in any kidney, ureter track or bladder). I spoke with my Urologist (who was also the Professor of Urology at the hospital I attended) and he said that it is common to experience pain like this (almost the same level as having kidney stones) for up to 2-3 months after this type of surgery and stent as the kidney tries to get back to normal. I was recommended to keep taking ocycodone/panadol with ibuprofen 3-4 times per day and to have Ural (3-4 times per day) and to drink 2-3 litres of water minimum a day which has given some relief but not enough for me to get back to a normal routine. I will be looking forward to my life getting back to normal

  2. jenny says:

    I had a 7mm stone lasered and a 3mm removed yesterday and I feel like im 90. I cant move for nothing. I have to wear a heating pad evetywhere i go. It sucks. Plus you feel bloated and fat.

  3. Juanita says:

    I had the surgery two days ago and I still feel like death! My dr said I could resume daily activities and go to work the next day!!!! He is surely CRAZY ….I can barely get off the couch!!!! And I am still pouring blood!!!!

  4. Michelle says:

    Hey I’m glad to see this. I am 3 weeks post op having had an 8.7mm stone removed by basket ureterscopy. Previous to that I was in and out of hospital for a week and on dilaudid for pain while they hoped the stone would pass. Also had a stint for 5 days post op. I am still severly fatigued and having pain in my kidney/flank. I am finding trying to keep up my normal daily routine is almost impossible. I get tired so easy and even run a low grade fever in the evenings. I’ve been checked out and there is no infection, Dr’s just say I need time to heal. It is discouraging though! I hate being stuck on a couch

  5. Paul says:

    I have a 10mm stone in my left kidney. Had 2 lithotripsy procedures to try and break it up, while they did, didn’t pass the whole stone. Just underwent a laser lithotripsy, and had a stent put in. They removed a chunk of the stone, and I’ve passed additional pieces as well. Felt pretty out of it after I came home from the hospital, but since then have felt pretty good, not much discomfort from the stent, but urine continues to be red with blood. Feel good enough to try and play hockey tonight! Stent is going to be in me for 2 weeks, then hopefully I’m done.

  6. Janneth says:

    I am so relieved to have found this thread, I had a urtheroscopy performed yesterday morning to remove a stone that was lodged in my urethra which ended up being two calcified stones into one. The procedure required a block epidural to numb the are from the waist down and a stunt was inserted. I was in shocking pain a few hours after the procedure and it required a hospitalization period for 24 hours. The pain was completly unexpected as doctors down play the whole procedure and say that the normal recovery period is of about 24-36 hours after the procedure. I am currently home and I am experiencing extremly painful urination and it is a sortt of bloody punch color. During the day pain seems to be tolerable for short lapses of time during which I try to walk to and from bed, but I have not been able to go back to class to take my final exams. I suggest that people plan for at least a week of recovery period and drink water with some sort of citrus, lemonade has helped me, Goodluck to all!

  7. Jacqui says:

    Oh no, I had a lazer blasting on a 10mm stone yesterday, and a stent inserted, thankfully I stayed the night in hospital as I required an injection of morphine to control the pain, which was unbearable! I’m home today, but passing urine is agonising, and bright red blood, the stent is so uncomfortable, and it doesn’t come out for 2 weeks. I have just phoned my Urologist to prescribe medication to manage the pain, he didn’t send me home with a script, but once I spoke to him was happy to fax one through to my local pharmacy.
    How long does this pain go on for? I own my own business and need to get back to work, but with this excruciating pain I can’t see how I could stand for 14 hours a day!

    Jacqui

    • Sarah says:

      Hi Jacqui, I’ve only just seen your post and hope you are feeling much better. My experience was that I had rather excruitiating pain for about a week. Following that week I worked reduced hours- I would get pain in my side or be simply too tired to continue at work. Whatever you do- give yourself time to recover and do not expect to be at work/working normal hours for at least a week and a half. You may be better sooner but, like I said below, I was still taking it slow nearly a month later! Good luck- also re stent- I didn’t Hv one but I don’t think it’s too uncommon for the patient to insist it be removed because Of the level of discomfort it can cause. Hope you feel much better soon!

  8. Brooke says:

    I was diagnosed with an 8mm stone in my left kidney after visiting the ER (the pain came on suddenly for me). I was immediately scheduled to have a stent put in. The stent procedure took about 30 minutes under general anaesthesia, and I was in the hospital overnight (mainly because the procedure was done in the afternoon and I was in a significant amount of pain post-procedure).

    I was sent home with no prescriptions, was told to use over-the-counter medications for the pain (!!!). The pain was nearly unbearable – I still had the stone, and now also had a stent which caused more pain and also caused visible blood in the urine (colour of fruit punch). I went to my GP to get pain meds prescribed – Panadeine Fort (paracetamol,aka acetaminophen, plus 30mg codeine per pill, dosage is 2 pills) as needed (every 4 hours, max 4 times a day) and Celebrex (anti-inflammatory once per day). These mostly did the job, but will note that the stent was difficult to live with. It was uncomfortable to even walk around, even a small amount of walking e.g. to and from the train station from the car/office resulted in noticeable increase in blood in the urine.

    My ureteroscopy procedure (to blast/remove the stone) was scheduled a week later (could not come soon enough). I was admitted in the early morning, and the procedure took 1.5 hours. Luckily, the urologist was able to use the “basket” device to get all of the stone bits out, and made the decision to NOT put another stent in. I was sent home the same day with three pain meds: Oxycodone (20 capsules to take as needed, max 4 per day), Tamsulosin (3 tablets, one per day for three days – this drug helps with the kidney and ureter spasms), and ibuprofen.

    The pain after the ureteroscopy was nearly unbearable. The first two days after were miserable, and I was barely able to keep on top of the pain. Emptying the bladder was especially painful (once emptied, the pain was sharp). I have not experienced any urination pain/stinging, luckily! The Oxycodone did not really help me with the pain unless I also took (at the same time) 800 mg of ibuprofen. I am using Panadeine Extra (which is over-the-counter here in Australia, and has 15mg codeine per pill, 2 pill dosage) three times a day + ibuprofen, and then at bedtime I use the Oxycodone + ibuprofen. I also took lots of hot showers – when the pain hit, I would dose up (if it was time for it) on my meds, and jump in the shower. The hot water really helped ease the pain until the meds kicked in. I also have basically lived with a heating pad as a mandatory accessory. And I’ve been trying to drink LOADS of water, as everyone has said that helps with the healing.

    My experience re: pain after the procedure:
    Procedure day: Pain level 8, difficult to stay on top of it
    Day 1 after procedure: Pain level 8, difficult to stay on top of it, very painful to empty bladder
    Day 2 after procedure: Pain level 7, able to stay on top of it for the most part, painful to empty bladder
    Day 3 after procedure: Same as day 2, but no longer painful to empty bladder
    Day 4 after procedure: Pain level 5, able to stay on top of it for the most part

    Will hopefully see great improvements in the next week!

    • Brooke says:

      Day 5 after procedure: Pain level dropped to 1 or 2 (mostly an achey back and also an ache where my left leg meets my torso) and also no more blood in the urine (at least, not visually detectable). Was able to go back to work, and only took two doses of Panadeine and one dose of Ibuprofen. Feeling MUCH better!

      • Sarah says:

        Hey Brooke glad to hear you are feeling much better! I was in bed for basically 7 days after procedure- every night I had unbearable flank pain and cramps. After bout 7 days things settled a lot!! Was amazing. It’s now a month later and I’m quite good- not able to do much physical exercise and get really tired- at about 3pm I feel like i need a nap! I should note that my work is sedentary but requires a bit of concentration. I still use heat pack at night and get a bit of a sore kidney after sitting all day at work… Interested to see what you’re/anyone else is:’/has been like a month or so after surgery!

        • Brooke says:

          Hi Sarah, glad you are doing well, too! Its now day 8 after my procedure, and I am pain free.

          Day 5: Took one dose of my codeine pills, and otherwise just had paracetemol (tylenol) and ibuprofen. Still used heat pack, and had periods of pain (where I went more than 5 hours without pain meds and then had to get on top of my pain again).

          Day 6: Completely off my heavy meds, just on over the counter stuff. Took them every 4-5 hours, only had one point in the day where the pain got to me and had to have my heat pack.

          Day 7: Only had to take two doses of pain meds (OTC stuff), just achey. Not using heat pack anymore.

          Day 8: Today was great, did not have to take ANY pain meds, and no heat pack, no pain. I am definitely still recovering, in that I’m tired. But feeling really great. Hopefully this will keep up!

          • Julie says:

            Just wondering, I am a stay at home mom, have uteroscopy tomorrow morning scheduled. I have a two and a four year old mother in law will be watching them while I have surgery, and then my husband will care for them that night but the next day I am on my own with kids. So day after surgery I will have to care for toddlers,, will this even be possible for me to handle? The nurses are making it seem like it will not be that much pain.

    • Louis says:

      Hi,

      I was diagnosed with a 1cm cubic proximal stone and was scheduled to remove with URS/Laser 3 weeks ago. While performing the procedure, the urologist discovered a stricture in a section of ureter. Nothing can go through until the urologist inserted a kind of wire used in heart surgery. So, instead of removing the stone, a stent was inserted between my left kidney and the bladder to allow the swollen kidney to pass the urine down to the bladder. I have been having the stent for 3 weeks.
      There was blood in the urine for the first 2 days. No medicine was prescribed despite a number of requests to the doctor. I was told that it will bleeds whenever I pass urine. Luckily, I have done some research for an alternative medicine for preventing inflammation and bleeding (at least not every time if not stop it at all). I have not experience any fever(supposedly an indication of bad infection in the urinary tract). I also notice doing the following helps:-

      I) Keeping a straight/erected and relax waist or lumber. (I’ve got bloods in urine once after intercourse because I bent my waist. That happened too when I did some Taichi push hand exercise with friend because I didn’t keep my waist straight and relax. Once I maintain the right posture without bending there’s no bleeding after the subsequent Taichi push hand exercise. )
      ii) Avoid sexual intercourse at all if possible until the bleeding stop.
      iii) Ly down on the bed and take a nap will reduce the burning sensation experienced and bleeding too.

      I have been using a herb now at a very small quantity that stop the bleeding totally as long I follow the rule I and ii above.

      I am going for the second operation to remove the stone and may be also cutting the stricture. I was told a combination of URS with laser and ballooning to enlarge the ureter will be used to remove the stone.

      Hope the above experience I have shared above will help some of you to reduce the bleeding and pain.

  9. Sarah says:

    Hi guys, I had surgery about a month ago to remove a stone. I too experienced severe pain- It was agony. I was basically bedridden for 7 days and unable to return to work. If I wasn’t having severe pain in my side I was so exhausted I couldn’t do anything but sleep. It’s now nearly a month later and I still get occasional flank pain, have v little energy and have been unable to do any form of physical exercise. I am only 26 and used to run daily. I completely agree that the surgeons completely underestimate the side effects of stones/surgery. Interested to know if ithers who have had surgery have suffered flank pain; pain in other kidney; and noticeable fatigue sine surgery. Good luck to those of you who have surgery scheduled- my advice, clear your diary and make sure you have someone on hand to play nurse!

    • j says:

      My spouse had lithotripsy, over a year ago. She had an infection specialist watching over her after the procedure. Hospital stay was 7 days. She was told that the urologist should have waited until her Urinary Tract Infection healed before the lithotripsy procedure. Reason is…a stint must be inserted in the ureter to allow the pieces of stone to fall out of the bladder.
      The infection specialist said the air pressure used to open the ureter to insert the splint is what did the damage. He said he did not realize the amount of air pressure used to insert the splint until he watched the lithotripsy procedure. He could not imagine the damage done with that amount of air pressure on a patient with a Urinary Tract Infection when that amount of air pressure.
      Oh, and my spoke accidentally pulled the 1st splint out, while taking a shower. The urologist inserted a second splint.
      Needless to say, my spouse has had pain in her left kidney, since the lithotripsy, performed over 1 year ago.
      I told my spouse to get a second opinion. Two other urologists refused to see her. Told her that she must return to her original urologist.
      Eventually, the urologist that performed the lithotripsy, refused to see her.
      My theory is that my spouse has “tissue scaring” throughout her bladder & kidneys due to the air pressure of the splint installation….nder a severe Urinary Tract Infection.
      The urologist did refer my spouse to a pain clinic. It appears she will have chronic pain for the remainder of her life.
      Yes, she has depression. And she can no longer hold a job. And our relationship is deteriorating.

    • Angela says:

      Did you have a eureteroscopy treatment ?

  10. JB says:

    After a failed ESWL, I had a utereroscopy a few days ago to address and remove 2 stones which showed on countless KUBs and my first CT scan.
    When I was in recovery, my doctor said that nothing was removed because one stone is deep in the flesh of the kidney while the other one might be a calcification.
    I feel depressed after having gone through 2 procedures with no productive results.
    Has anyone here ever heard of something like this? This is my first experience with stones so I don’t know what or who to believe anymore. Thank you!

    • barbara says:

      Hi JB

      I also had a failed ESWL. Had one stone in each kidney. Dr. got the one in the right kidney using ureroscopy laser, but the one in the left kidney was embedded in the tissue so he left it. Dr. said eventually I will pass it. I am frustrated and to know that I have yet one more stone too pass. Your doctor at a later time may attempt another ESWL. Good luck

  11. Stephanny says:

    Can you have this procedure while on your period? I’m scheduled to start mine on surgery day of all days.

  12. jean says:

    Ok I’ve had percutaneous kidney surgery I’ve had 4 lithotripsy procedures and just had a second laser lithotripsy done last week. Let me tell u coming from someone who is a kidney stone expert this last laser lithotripsy about killed me. I spent two days in the hospital and am ready to go back. The pain is the worst I’ve ever had back pain stomach cramping with sharp pain forget peeing its horrific.still peeing blots and pieces if my urethra I’ve been crying in pain for three days since leaving the hospital.i can’t believe how bad this is.help

  13. Heather says:

    I have a large 11-12mm stone, I am not sure to when it formed as I have been hurting for the last 5 or so years. I just attributed the pain to my having PCOS. I had enough and finally broke down and went to the ER. They did a CT scan and said I had a stone. Pretty much pushed me out of the door and sent me to another doctor. I had a massive kidney infection due to the stone the new doctor told me. We have done some tests but all my levels come back normal or below. So they don’t know what this thing is made of. I am literally stuck between a rock and a hard place. I sadly have no insurance. I tried the healthcare.gov thing, they said I do not qualify. Nobody wants to even talk to me with out insurance. Our great commander and chief Hitle….I mean Obama has caused me a whole lot of pain and grief in a indirect way. I have never been on any kind of assistance but I was even considering Medicaid, but… I don’t qualify even though my income is below what they said was needed. When I tried to sign up before on the health care market place ( several times) the system was a mess, so now I have to wait to November to get coverage. I have no idea what I should do I have never had to deal with this before. My doctor is great to me but I am sure he will not advise me or let me to stay on the pain meds he has got me on until then. I really don’t want to have to cut this thing out with a butter knife myself. I live in Georgia if there is any suggestions yall could give me that would be awesome. I don’t know what else to do. Sorry for standing on my soap box for so long… just frustrated. :)

    • Kirsten says:

      Hi Heather,

      I too am suffering from a 11mm-12mm stone. I wanted to let you know that there are some options available to you. Does your community have a free clinic? I visited one a few years ago when I started getting stones. After the referral to a urologist and a lithotripsy at the hospital, I only owed around $2,000 and was able to get financial assistance from the hospital to forgive my bill. You might want to consider that.

    • Stephen says:

      Heather,

      I also had a 12 mm stone and am recoering (I hope). Best of luck on yours.
      Don’t blame Obama or Obamacare. If there’s any blame, it rests squarely on your State government which refused medicaid expansion. You should be thankful for Obamacare because it guarantees that you can get insurance at a reasonable cost despite your having a pre-existing condition. Before Obamacare, this was not the case.

      • Rick says:

        Really Stephen?

        Heather’s struggling and you’re hawking ObamaCare? I’m sure she feels so much better after your comments.

    • Rick says:

      I’m so sorry Heather. I wish I had an answer for you. I’m just recovering from a two-week assault on my renal system by a stone (three ER trips, lots of Percocets, and outpatient surgery to remove). Luckily I have insurance, unfortunately it has a $6000 deductible!

      Are there any university hospitals in your vicinity? I know sometimes they’ll work with folks without insurance, especially if their case is unique.

      In any case you hang in there girl and all our best to you.

  14. Mandy Long says:

    Had my procedure done 29th May and went home same evenin as felt fine, however suffering from really bad pains in kidney area on side procedure was done, the painkillers issued from the hospital are useless and don’t even touch it, I’m having to use suppositories prescribed for the attacks before removal, these pain attacks though always seem to be at bedtime or the middle of the night, I’m OK during the day, can anyone tell me is this is normal or should I be concerned? No catheter or stent was required post removal so that’s not the problem!

    • Allison says:

      I can sympathize with you. I had ureteroscopic stone removal, both sides, on May 9th and I still have residual flank pain almost a month later (no stents this time…YAY). This was my second ureteroscopy in 2 years. I’ve also had ESWL. Unfortunately, stones keep coming back :-(
      I had an xray a few weeks ago to follow up on the procedure and there are still multiple stones 1-3mm in both kidneys. Sadly, when I had a CT scan last year, they found a lesion on my left kidney and when they did a follow-up CT scan a few months ago, they found another lesion on my right kidney. They have done urine cytology tests including voided urine, renal washing, and FISH test which came back positive. The urologist isn’t sure if I have cancer or not because the lesions are very small & he didn’t see anything suspicious during the ureteroscopy. Guess I just have to keep waiting and we’ll see what happens. I hope your pain gets better soon.

    • Rua says:

      I just had the procedure done on the 3rd. This time I was unlucky enough to have larger stones that had to go via laser. I am usually pretty good with pain, but I’ll have to say that the pain and issues afterwards are quite understated by urologists, most bloggers and the medical websites (unless of course my equipment is somehow different from everyone else). I believe that urologists should have to go through the procedure themselves as part of their training and then have to live with the stents for a good week. Maybe then they would come up with some better and less barbaric ideas on how to deal with stones. In my case, let’s just say that I now firmly believe that the male equipment is not designed to have wires and tubes stuffed up it in the opposite direction. I woke up feeing the wrath of the sadistic roto rooter. The first 4-5 times urinating was far worse than passing any of the stones that I have had. It was definitely a new level of conscious agony. The stent afterwards is really annoying and you just can’t turn it off. My urologist knew that I’d have a problem with the stent and I woke up to find that I didn’t have any strings available to remove the stent by myself. The urgency, pain, discomfort are all present. Now 3 days later, I am finally getting to the point of where my constitution has awakened. I am super glad that I have not missed any of my colace and that I have been drinking 100% blueberry juice, tart cherry juice, prune juice and eating pears. At least that part of returning to normal was not as bad as I thought it was going to be. I have to have stent in for a week. As far as time off from work goes, I am so thankful that I can work from home in more comfortable environment. My heart goes out to all of you that have had to return to physically demanding jobs immediately after the procedure. This sucks, and you can’t know how bad it is until you have gone through it. Anyone who says that their procedure was easy and ‘not a problem’ must really have a big urethra and uretors.

  15. Billie says:

    I just had Uteroscopy on an alomost 10mm stone. Surgery was easy. Better than Lithotripsy that I have had in past. The worse part was the Stent I had for 5 days. It was uncomfortable.

  16. brandy says:

    I had lithotripsy on a 10 mm stone. It did not work well at all according to the urologist. Anyone had another procedure to have a similar size stone removed,and if so how was it? Any info u can give is appreciated! Thanks

  17. Ruben says:

    I had my stent removed, the next day I felt okay. Then went back to work; that evening I thought I was going to die: my left side and back hurt so much that I could not find any comfortable position. How long after removal of stones and stents should I feel better?

  18. de.idr says:

    i have had 11 lithotripsy procedures..wed i will having the first of many laser.lithotripsy..dr sai my kidney is a runt not working like it should….it has had the sh$_& beat out of it.my right side hurts.cause its worki.g twice as hard

  19. Alex says:

    I had a 14mm stone in left kidney with surgery on 4/22 in the evening. A stent had to be placed. (to remain there for 10 days) The stent seems to what is giving me a lot of the pain in addition to my left side of where the procedure was done. Very uncomfortable to stand. Standing and walking with stent, is cumbersome for me. It feels as tho you need to void your bladder any time I’m up. Energy is lacking, as well, but I had a sepsis and kidney infection from an upper UTI, before they found the stone. All of these are compounding my recovery time I’m sure. This is my first stone ever, at 46. Today is my first day back at trying to do my job. I did bring my heating pad with me and pillow to angle it around me on the side that the procedure was done. IT’s rough. I am not so sure it was good I tried to come back after just a week. I would say it depends on what you do at work and if you will have a stent in place. For myself, the stent has been the worst part. And I don’t normally have to take pain meds, but I have for this. They didn’t give me enough for 10 days, which I had to go get more and am rationing them out till they take the stent out. Hoping the dang stone is broken up enough. What I have strained doesn’t seem like much then sand and not very much of that for the size stone that was stated. Tho, more can come out later on from what I am told.

  20. Misty says:

    How long should I take off work? I am having the surgery done on monday. I was hoping to go back to work 2 days after surgery.

    • Billie says:

      I would say depends on what you do. If you have a sit down job should be ok. Im on my feet alot. I stayed home a week.

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