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.

106 Responses to Ureteroscopy

  1. YVONNE says:

    PLEASE TELL ME WHAT A PROCEDURE ICLL IS FOR REMOVAL OF A RIGHT KIDNEY STONE. DOCTOR DISCUSSED PROCEDURE WITH ME BUT WENT ON VACATION AND HIS OFFICE IS NOT RETURNING MY CALLS…………….. THANK YOU!!!!

  2. GrumpyGrampy says:

    I had a pyeloplasty for a kidney repair about a year ago, where they make an incision through your side, and the stent caused me more discomfort than the surgery. My nursey friends all said I should have asked for B&O (Belladonna & Opium) suppositories to control the bladder spasms. Just had a URS with a stent to remove a large stone earlier today and insisted on a script for B&O before discharge … so far they are working like a charm!

  3. Gina says:

    Ive suffered from kidney stones for along time now, I’ve had two lithotripsy procedures done one on each kidney and just a couple days ago I had the urethoscopy done with a stent and omg the pain… my kidney stone was 9cm and I was in so much pain I went to the emergency room one night they did a CT and found that it wad a size 9 and sent me home with pain meds and told me yo contact my urologist. I ended up going back 2 days later with severe pain this time they admitted me .. the actual surgery was fine the aftermath is painful I feel like I still have a huge stone… I hope this pain goes away , I know I will always deal with stones but next time im going to ask not to have a stent.

  4. Becky S. says:

    I had a 1.4 cm stone that my urologist treated with the ESWL. About 2-3 hrs after I got home, the pain was excruciating as the extra strength Tylenol I was sent home with was not helping with my pain. I called my urologist and he told me to go to the ER. They took a CT scan there which showed the 1.4 kidney stone broke into 3 smaller stones and tiny gravel sized stones and my pain was due to the passing of these tiny gravel sized stones. I was given morphine two different times and sent home with morphine tablets. A few hours later, my urologist told me to come to the hospital and not to eat anything as he wanted to put a stent in to help pass the stones easier. The stent made the pain go away but there is great discomfort with the urge to urinate every 30-60 min. I also have bladder spasms. There are meds prescribed which I take, but they make me nauseous. It’s been a week and I have to wait 3 more weeks before the urologist will perform a ureteroscopy and take the three stones out. Hopefully he will take the stent out too at that time. The stones will be sent to the lab for analysis and I will adjust my diet accordingly plus I will ask to be given preventative meds as I do not want to get stones again. The passing of the tiny stones were very intense pain which I have felt before—like labor pains when I had my two kids. I am hoping for no complications with the ureteroscopy and to be back to normal a week after that. Good luck to all!

  5. hana2659 says:

    I has uterenoscopy and laser lithotripsy both kidneys on Saturday and can safely say the doctors dramatically underestimate the recovery time and post op pain when stents are involved. I was discharged Sunday after 1 night stay only to return with uncontrollable pain on Tuesday and have no successful pain relief until I was catheterized on Wednesday not even diazepam or morphene helped me. The bladder was refluxing back up the stents to my kidneys. Please think about this procedure if you require stents, I am 28 – non smoker, not overweight and I had two stents fitted during the op which my body is rejecting. This is the worst pain i’ve ever been in my life.

    • Jason says:

      I have had two laser procedures. In the first I had a stent put in. It was nothing short of torturous. I insisted he take it out and that procedure, too, was painful, traumatic even. The following year, I got another stone and again my urologist elected the laser procedure. I insisted on no stent and he complied. My results were good. Four years later, I’m about to do it all again, and again I am insisting on no stent.

      • Brian says:

        I know what you mean.i have had lithrotripsy 2 weeks ago,uteroscopy last week,and tomorrow i go back in again for uteroscopy.i really hope it works this time.driving a truck all day with a stent is very uncomfortable.12×9 mm big stone lodged in the uterer.wish me luck!

  6. Al says:

    Anyone who thinks that surgery is totally painless is simply deluding themselves. When a doctor must enter the body – either via a scope or a scalpel – there will be some discomfort. Since we all respond differently to pain, AND doctors vary in their technique for stone ablation procedures, one cannot cross-compare experiences with any real sense of validity. What is minimal pain for me might be grossly incapacitating for you, and vice versa. There are other factors in play too, exact position of stone, how much damage (abrasion of ureter, etc.) did it do before treatment; is there partial or complete urinary obstruction, etc,. that can figure greatly in the level of pain one experiences.

    During the past 5 years, I have had 6 stones dealt with via ureteroscopy and laser lithotripsy. The calculi ranged in size from 4mm to 1.2cm – and the discomfort I experienced post-surgery with stent in place was minimal, almost nothing compared to the full-blown pain of renal colic when a stone is obstructing urinary flow. Post surgical stent removal is simple and only causes momentary sting as it passes through the urinary bladder and its sphincter on the way out.

    For me, laser lithotripsy is the only way to go, provided the stone(s) are of a size and in a location that is treatable by this procedure.

  7. Courtney says:

    I had an 18mm stone into right kidney diagnosed at the ER three weeks ago. My kidney was blocked up due to the stone and the Urologist put in a stent. One week later I was given lithotripsy. I didn’t find this procedure painful. I was sore in my right flank but nothing too bad. The stent was and has been the WORST part of these procedures. They are extremely painful. A week after the lithotripsy I was x-rated only to find out the big stone broke into three pieces. I had to keep the stent in and was scheduled for ureteoscopy. After going through the lithotripsy without a lot of pain I didn’t expect this to be as bad as it is. I had the surgery yesterday 8am and I’m in the worst pain I’ve ever felt. The medication isn’t taking the pain away. I have to keep this stent two more weeks as well. In my opinion, I’d rather go through lithotripsy multiple times than go through ureteoscopy even once….

    I wish you all the best of luck with your stones!!

  8. Anne says:

    I had bilateral laser lithotripsy 5 days ago. Was very nervous, especially about having general anesthesia, but I’m doing OK. I have experience NO pain to speak of. The urge to pee and the discomfort of it seems a lot like urinary infections I’ve had in the past and I’m looking forward to my one week graduation to getting the stents removed! I’m taking antibiotics for 10 days, that’s pretty routine I think. My urologist told me I’ll have some bleeding until the stents are out so nothing to worry about there. I’m having no problems with incontinence so the person who asked if this is normal…the answer is no. I just recently found out that Flomax can greatly help with the pain of kidney stones. Yay! The real bummer of this procedure, or any other stone procedure, is that the stones are sooner or later going to come back no matter what we do. I think this method beats shock wave lithotripsy by a long shot. I was told I’d need four sessions and even then might not get them all. Yikes, I don’t want to do that to my kidneys!!! For anyone reading this heading for surgery all I can say is it isn’t going to be as bad as you think. Good luck!

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