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.

134 Responses to Ureteroscopy

  1. Matt says:

    I had a Laser Ureteroscopy done on Jan 8th. My doctor put stent in and removed it on Jan 14th. After he removed the stent I passed blood clots almost everyday. some days my urine was crystal clear but other days were dark brick color. Today seems like I’m bleeding again trying to reach my doctors office but because of the holiday they are not answering.
    My question is, Is the bleeding normal after almost 11 days after the surgery? How was your experience with this procedure.

    Thank You in advance,


  2. christina says:

    I had a ureteroscopy to remove a 6mm kidney stone from near the bladder last Thursday (8th Jan), the discomfort from the catheter seems to be easing but I have tenderness, rash and what seems to be general bruising on my right side (the same side as the stone was removed from), from the front of my body, around the side/flank and around my back. Is this normal?

  3. Pingback: If You’re Stoned, You Have 4 Options | My Urology Doc

  4. Chad says:

    I’ve seen studies released in recent years showing that uncomplicated laser lithotripsy of stones under 1cm shouldn’t require a stent. I’d love to get replies from people who have had doctors actually avoid stents about complications.

    Have you had laser litho without a stent? If so, did you have any of what we see in others, such as clots, stricture, pain, etc?

    • Buckshot says:

      I’ve had 2 ESWL in the last 3 weeks for a 19mm glob of multiple Stag Horn Stones. The stent took 5 days to get used to.. Peed 150+ times each of first 3 days. It was a pain but NOT painful. Slight kidney area soreness but no pain, no pain relievers required. Did not pass much debris for 7days, never pain passing fagments and no bleeding. Small red area on flank for 4 days. After 2nd ESWL I did not have a single symptom that I even had the procedure done. This time there was no getting used to the stent since it was already in there. A little debris the 1st 9 days then the 10th and 11th days (Today) lots of bigger pieces came out, but No Pain. I felt them after they left the bladder but no discomfort. Found out today I still have at least 1 to large to pass and will have Laser surgery next week to finish things up, the stent may or may not be put back in depending how it goes. Stent discomfort is much better than having your ureter swell shut from tramma. Not looking forward to it coming out in the office but the discomfort is very quick. After the laser surgery I expect soreness and probably major pain peeing for 2 days. I will update after the Laser Surgery. I know I have been lucky (so far) with no pain, the stent has caused me to pee 3-4 times per waking hour.

  5. Elizabeth Quackenbush says:

    I’m scheduled for lithoripsy tomorrow with stent placement tomorrow at 4:30 p.m. Stones are 8 mms and 14 mms.blocking urine. First time , pain ? My first in 2008 was shockwaves, pain backed me up against the wall. HELP.

  6. Cody says:

    10 years ago I had a 7mm stone. I had the ESWL procedure done and it broke it up like little grains of salt. Only problem I had was a bruise and no appetite for 2 weeks as it felt like my stomach was up in my chest. I now have a 5mm stone and they are going to do the laser lithotripsy. After reading all these comments I am scared for my life as I don’t do well with pain. Wish me luck !

  7. Siddha Raj ojha says:

    5 days ago. I had a pain in my left side of the waist. god! I am still frightening! then ln medical examine showed there was a LT sided hydrnephrosis with LT uretric calculus, &the same day I had a liithotripsy. There was no pain but I have a great weakness.

  8. beverly gray says:

    I don’t want to scare anyone but on Oct. 16 I had a uretoroscopy for a 1 CM stone. Doctor said it wouldn’t not be painful and gave me a perscription for tylenol with codiene (what a joke). Came out of surgery and the pain was excrutiating. I was in recovery and the pian was so intense my blood pressure jumped to 210/101 so they admitted me. I was in 1 full day for pain management then went home, pretty miserable. Ten days later I developed a fever that went up to 103.5. I was delerious and pretty crazy. I have alost no memory and went to emergency. Peed on the bed, screaming f or help, so anyway at 6 a.m. they decided I needed another stent put in (first had been taken out a few days before. So I went into surgery and was admitted for 4 days. Discharge papers ay I had sepsis…. Well, I went home and 6 days later had 102.8 so was admitted again. again they said i had sepsis. I didn’t know what it was but have since learned it can be quite serious not to mention the massive pain. Thursday I have to go get the stent remnoved (YIKES!) and he’s doing a cycsoscopy and another ureteroscopy but it houldnt be so bad because there is no ore stone to crush, at least I hope. I pray it works out because this crap s going on from 10/16 to now…. Just check out all options….

    • ginger says:

      I went in to ER on 12/2/14 with a blockage. This blockage caused sepsis also. I have been very sick this whole month. So much antibiotics. I run a low grade temp everyday. Passing blood clots and severe bladder spasms. I have stayed nauseous and in so much pain. I am getting my 7 mm stone out 12/26. I dread this. I know they will put a new stent in. I have had this stent since er visit. Today is the first day I could sit up with out crying. I am a pretty tough person. Live with chronic pain but I think the infection and stent had put me over the edge.

  9. Nikki says:

    I had my 18th surgery to remove a 1cm stone yesterday. My first several surgeries were ESWL and the rest have been ursl. I always have immense pain during the days after when I have a stent (usually 7-14 days) and have quite a bit of renal colic and pass small clots when the stent is removed for several hours after before it subsides. I passed a large and painful clot about the length and width of 2 fingers followed by several quarter sized clots. My blood was brick red (per usual) all day yesterday and has since moved on to a dark cloudy brown (due to the clots I imagine)Post op instructions are always to seek immediate medical attention after surgery if you’re passing blood clots, and this was my first of that size. I did call my doctor (he’s been my dr for the past 15 years) and he said that normally this was alarming but given my history with the amount of trauma my ureter has experienced in the past 15 years and because I have a blood clotting disorder that he’s not too alarmed but if it continues through tomorrow he would meet me at the hospital (they’re office is closed tomorrow). Has anyone experienced clots like this? I generally drink 2 or more liters of water a day as well as fresh lemon water (I make uric acid stones and my cotric levels are low) and I increase my water intake when I have a procedure. Is there any recommendations to lessening this? I haven’t been moving much-moving moves the stent and causes more blood in the urine. I’m fairly stoic in pain after so many times, but passing that make clot made me scream.

    • Renee says:

      I have had the same surgery a couple of weeks ago. The first surgery I was admitted to the hospital, went home with a stent. A few days later the stent was removed. I then go into massive pain. I was taken back to the hospital by ambulance. So one week after the first surgery a second on was done. I had two stones 8mm. Still another one stuck up in my left kidney. After the second surgery I was in even worse pain. I took a shower in the hospital shower. When the hot water relaxed my lower back I started passing huge clots. Maybe 10-15. I understand now that there was damage done to my kidney due to the surgical procedure. I stayed in the hospital for 2 more days going home with yet another stent. After several of pain….I couldn’t control it anymore….on a scale of 1-10… I was in a 15! Again I went to hospital in ambulance. My ER Doc said I needed to find another urologist…as that I probably had nerve damage. I had the second stent out yesterday….I feel better but I am still in a huge amount of pain. BTW way I had some Cipro antibiotic at home and started taking it. I believe I also had an infection in both kidneys by now and pneumonia in my right lung from two general anesthetics. I’m over 60….not a good situation. I am praying that things improve….

  10. praneeta says:

    i had ursl 14 days back.they removed catheter the day after the procedure and said i have no stent and everything is cleared.but i have a slight pain in my back and abdomen probably kidney and ureter part is it common or do i need go to the dr immediately .pls suggest

  11. stephen says:

    I am peeing blood 2 days post op. Is this normal after lazer. I have a stent in me 4 x6 mm stone that was not found. Taking 6 tablets of acalka a day for 1 week and antibiotics

  12. Mark says:

    Had my stone blown up on Thursday. It’s Sunday and I’m still experiencing no appetite, nausea and all over sore. Has anyone else experienced this? Last time I had it done, don’t remember feeling this bad for so long.

  13. Mike says:

    Today I had laser lithotripsy for uric acid kidney stones. I’m in no pain despite the catheter & 2nd temp stent (the 1st was replaced which I’ll explain) I have which will be removed tomorrow. I have an upset stomach from the general anesthesia I had to have (I wanted a spinal again after last month’s procedures. I’ll explain shortly).

    In 2009 I had shockwave lithotripsy for kidney stones & went back to work the next day with no pain/side effects. Because of the BPH I had, the stones apparently collected in my bladder, of which I was unaware (but I knew I hadn’t passed any). I didn’t have symptoms until Dec. 2012, when I experienced pain when urinating. I assumed a UTI, which the tests came back negative for. Several months later I had an ultrasound & CT scan (the VA moves glacially) which identified the bladder stones.

    Initially, I scheduled surgery with the VA, but was unhappy with the treatment the VA offered. I decided to go with a private doctor & I’m very happy with the results, so far. Because of weather, scheduling & other medical complications, my surgery was finally scheduled for last month. I had Pneumatic Cystolithotripsy (or Cystolithopaxy, whatever the case may be) for the stones & “Button” TUVP for the BPH.

    I was hoping the kidney stones would be done at the same time, but the bladder/BPH which was scheduled for 2 hrs., went 4 hrs. I went home with a (leaking) catheter & temp ureteral stent. My discomfort was from the stent, which caused me to have (IMHO) excruciating pain in my kidney when peeing before & after the catheter was removed (I was blind-sided with that as the doctor didn’t tell me it might happen). It eventually subsided, but I would have preferred to be alerted.

    Peeing is returning to normal with no incontinence & sexual function is status quo. Which brings this way too long post to the beginning of my story.

    • Mike says:

      The catheter was removed this morning, but the stent won’t be removed until next week in the doctor’s office. Bummer. I have no pain other than some irritation in my urethra, which is to expected, I guess.

  14. Terry says:

    Hi all
    I had my first experience this morning (16 hours ago) with the laser processing to break my 7MM stone. Yes there is pain involved, the worth pain was right after recovery and last about 6 to 8 hours , most pain was in the penis area during urination buy now almost 17 hours later it is much less pain and the discomfort is going down slowly, the meds I got was antibiotic, pain killer and the red pill (which makes your pee red/yellowish color) it contain local antistatic and it sure help reducing the pain during urination.
    The doctor told me it will be more painful passing the stones out and after that removing the stent will be very short uncomfortable process that takes one minute , and full recovery should be within a weeks at the most (vary with each person) I think it is much less pain that I except during the first 6 hours or so. I will post the final as soon as the stent removed.
    Good luck to you all

    • Denise says:

      My experience sounds similar. After visit to emergency room last Friday in excruciating pain found 7mm kidney stone at opening of Uretha. Doctor placed a temporary stent to clear blockage and I returned yesterday for the laser lithotripsy to break up the stone and a second stent to allow stone to pass. Hoping to pass pieces of stone quickly, I’m drinking water like crazy, as can’t wait to get back to my normal self. Scheduled to have stent removed on the 19th but am hoping for sooner. Plesde post your progress it’s encouraging to hear other similar stories that turn out well.

  15. YVONNE says:


  16. 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!

  17. Mishell says:

    I am still within 24hrs of having Ureteroscopy surgery to remove a 6mm kidney stone that was laying pretty close to my bladder. After I woke up from surgery I was told that they couldn’t find the stone there. They had shot dye through my urethra, so they looked around my kidneys to make sure it didn’t get blasted there. Needless to say, after looking all around, they assumed I must have passed it in the last week and a half. Apparently if it drops into the bladder, the pain isn’t as intense then if in other areas and can pass quite easily. I, of course, didn’t have a stent put in, but I’m wondering if anyone knows how safe it is to start intercourse with my husband again. A bit of an embarasing question, but I forgot to ask my doctor. Thanks and good luck to anyone going through this.

  18. 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.

  19. 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!

    • beverly gray says:

      pray you have no complications with the ureteroscopy. I wrote above about my experience which was nightmarish. That doesn’t mean everyone’s is but mine was extremely painful and I developed sepsis….. Wishing you the best.

  20. 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!

    • jennifer barnard says:

      Hi thank you for the warning of what to expect im off into hospital on the 5th i was told its a straight forward op and to be off work for at least 3 days. I was taking some annual leave but just might change my mind. Thank you.

  21. 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.

    • Amy says:

      Al, your comments are so helpful! I just got home from the hospital where I had the Ureteroscopy and lithotripsy on both sides (2 stones passing at the same time lucky me) and while there is discomfort and some pain it is no where near the pain that sent me to the ER last week when both ureters were blocked and there was no urine flow. The stents are uncomfortable but I’d rather be safe in case of swelling than have that horrendous pain return. Hoping Motrin is enough to do the trick because I don’t get the luxury of taking time off work! And the stents will be removed in a week so what’s one more week of being uncomfortable.

    • Jayne says:

      I have a 6 mm stone, I am due for Lithotripsy on Monday. I have a stent put in now, and I can’t even tell I have a stone lodged in there. I believe the doctor said it was still up by the kidney. This is my 6th stone and I have past all of them without help. I’m really nervous about the procedure I will be having and one thing I was adamant on was taking the stent out right after the procedure. From what I have been reading it appears it hurts less to leave it in for another week as the stone fragments pass. Do they numb you or anything when removing the stent in the office? I don’t deal with pain well at all!!!

  22. 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!!

    • Hessie28 says:

      Same problem. My stone is over a Centimeter. 3 wks ago I had the Uretrascopy. Stent in for 3 wks. I go in a few hours for the next one. The stent is a nightmare. The Dr said I wouldn’t even know it was there. Yeah right. Mine feels like it is laying on my colon. Severe pain and problems going number 2. Wicked colon spasams every time I urinate. I just used a Glycerin suppository and it is the first time in 3 weeks I could go without wicked pain. I had emergency visit week two and have UTI. I take pain meds already for failed back surgery and they do nothing for stent pain. He is going to replace the stent today. Don’t know how I will survive. Last time he got half the stone. Hope he gets the rest today. Hope you are feeling good.

      • Jayne says:

        I have a 6 mm stone, I am due for Lithotripsy on Monday. I have a stent put in now, and I can’t even tell I have a stone lodged in there. I believe the doctor said it was still up by the kidney. This is my 6th stone and I have past all of them without help. I’m really nervous about the procedure I will be having and one thing I was adamant on was taking the stent out right after the procedure. From what I have been reading it appears it hurts less to leave it in for another week as the stone fragments pass. Do they numb you or anything when removing the stent in the office? I don’t deal with pain well at all!!!

  23. 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!

    • beverley lockwood says:

      hi Anne ive just read your comments on your surgery and found it most reasuring as im just about to have the same procedure, and im feeling really nervous, thankyou.

    • jennifer barnard says:

      Yes been reading different post and thank you im going in on the 5th nov snd not looking forward i have stones in both. And not looking forward but will be glad to get rid as im sick off back pain and feeling sick. Will be taking note and asking for appropriate pain relief and antibiotics for after. Thank you

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