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.

162 Responses to Ureteroscopy

  1. Patricia says:

    To be honest, I have been one of the rare lucky ones. No pain with kidney stone passing. They found one still in the kidney that was 1.2 CM and decided because I am –let’s call it ‘fluffy’- that the laser lithotripsy would be the best. I had that done May 21-2015 and all went smoothly, no pain, and I never had to take the pain pills the Dr. gave me. I could feel the stent but it wasn’t overly problematic–its removal was very swift and easy.

    What I am balking at is the ultrasound. Tomorrow I have to go in to get an ultrasound so they can check and make sure the kidney and ureter are not swollen. I’ve about had it with expensive medical procedures, medications and follow up appointments. Like most, it is appointment after appointment before anything gets done and I am just sick of it all at this point. Am hoping this ultrasound is the last of it.

  2. Kathy Day RN says:

    I had ureteroscopy and laser lithotripsy on June 5. My entire journey with this, the largest of my 3 kidney stones has been a nightmare from beginning to end. An early ER visit was a bust..only an urinalysis done, and so I had to jump through hoops, see two more doctors, get blood work and xrays, wait for results, for another 5 days to get my first stent placed. My stone is 1.5CM. My pain before the first stent was what I thought was level 9 or 10, and worse at night when I tried to lie down. But, I should have learned to crawl on all fours so the doctors would believe I was suffering. When I was seen…3 times, and in 3 different places my first week, they (except my urologist) were obviously not convinced I was in pain. I was generally loaded with ibuprofen, so I had no pain or low pain on exam. I enjoyed 2 weeks pain free with my first stend while waiting for lithotripsy. I figured after stone pain, that would be a piece of cake. Well, I had level 20 pain after my procedure, which started in recovery room. I got dosed several times with Fentanyl and finally with Torodol, enough so I could get my clothes on and get wheeled out the door. I should have been admitted for pain control. I endured the worst weekend of my life, ever (65 years old). I couldn’t eat, sleep, move, have a BM, and I could barely walk. I had NO pain control at home. The Oxycodone made it harder for me to walk but did not touch my pain. This is barbaric. Anyone who suffers a high level of pain in recovery room should be admitted for pain control, not shipped home. The only reason I did not go back to the hospital is because I would have had to go in an ambulance…I couldn’t have made it to my car in the driveway. And, I would have had to go to the ER, to the chaos, triage, and exposure to more illness, to get pain meds. My doctor could have just said he would directly readmit me. My pain did not decrease until late Sunday, 2 full days after my procedure. I plan to discuss this with my urologist today when he removes this ghastly stent. As a patient safety advocate I will now focus on this issue, and it is an issue. Nobody should have to suffer this kind of pain at home without effective pain medications or professional nursing help. There is a point where a “miminmally invasive ‘routine’ outpatient surgical procedure” becomes a huge difficulty for patients, and that is when they cannot get pain relief. There is no such thing as “routine” surgery.

  3. Susie says:

    Does anyone have any advice on alleviating the pain after this surgery? Any tips at all?

  4. Linda says:

    I had a 7mm kidney stone that was removed by ureteroscopy. I was just out of surgery and in a recovery room when I went to the bathroom to urinate and had so much pain I almost passed out. I have never felt such pain. I was then told that I would have some pain for the next week or so which made me burst into tears at the thought of going through such torture. That incident was the worst of the pain. However, pain continued all week. Severe cramping and lower back pain. I remember urinating a piece of red tissue, about the size of the very tip of my baby finger. It appeared to have been torn off. Because of the pain, the doctor took the stent out after 8 days. But it didn’t help at all. I made an appointment to see the doctor and he told me that I had a ureter the size of a child’s. Weeks went by and no improvement. Pain meds helped some, but it would not subside for a minute. I had some tests and all showed everything was ok. But the back and spasm pain continued. It’s been over 2 months and I am still recovering. I am fairly positive that my ureter was traumatized from the stent tube being too large. I am not sure if I will ever feel normal again.

  5. Lisha says:

    Well I am scheduled for the Laser Litho Cysto Ureteroscopy with Stent Placement this coming Friday and, well after having read all this I am apprehensive. I have to have it done though because I am scheduled for a Gastric Bypass on June 9th and if I don’t get rid of this 6 x 7 x 15mm stone which is obstructing my left ureter I wont be able to have my bypass because the stone is causing back to back to back in fections. Please pray my procedures go as planned and I get the lesser of all the stories told here.

  6. Mary nowak says:

    I was put on Flowmax at the ER on Saturday night. Had the stone removed this morning ( Thursday) and the only significant pain I have is a massive headache from the Flowmax. The headache is much worse than the kidney stone. I have taken 10mg Norco, and a Motrin. Still pounding. Has anyone else had this problem? For sure, I will not be taking any more Flowmax.

    • steve says:

      Mary, try taking the flomax right before you go to bed. I experienced the same headaches with flomax. My urologist advised me to change when i take it, to bedtime and i have not had any more issues with it.

  7. Jen says:

    I had hydronephrosis of the right kidney due to a 5mm stone stuck midway down the ureter. Excruciating pain that seemed untouched by my Percocet sent me to the ER. My dr did laser lithotripsy and left a stent. Procedure went very well as I went from a pain level of 8 to almost nothing. This was yesterday and I have had no need for pain medication, not so much as a tylenol. I am sometimes aware of the stent, in my bladder or in my back, but it is just uncomfortable not painful. I do feel the need to urinate more frequently but it is not uncomfortable. Dr will remove the stent with a local anesthetic in a few days.

  8. CiCi says:

    Yes, I had three stents because I have four ureters…..lucky me! Not all stones preventable as such many of us with the disease MSK. Recently had removed 25 stones and still recovering. Having had every type of stone removal procedure there is, in my battle with hundreds of stones, Ureteroscopy is the most sucessful but I cannot tolerate the lack of appropriate pain management and lack of attention to this important area. Make sure and discuss this prior with your physicians as well as an alternate plan post op other than going to the ER. Also inquire about avoiding stents…one physician ensured the stents were small (in diameter) and short, thus I did not have the same torment as I had suffered prior. One physician listened to me and we took the risk of not placing them and my recovery went great. This time the suffering from my three were unbearable so on the fifth day post op I pulled them.
    Try to stay in control of your care and lean on others for support during these times.

  9. Michelle says:

    I had a 4mm stone blasted in my right kidney. I had severe pain when initially passing the stone after surgery, then worse pain and discomfort caused from the stent and the absolute worst pain of my life after the stent removal continuous for another few days. The doctor did not send me home with any pain medication, I had to go back into hospital twice after surgery due to the pain and was then prescribed strong pain killers, I had to take them every 6 hours otherwise I was in complete agony. If anyone requires this procedure I would definitely ensure you give yourself at least 10 days to recover and definitely take the pain meds, even in the middle of the night. The mornings were the worst for me.

  10. Marie mccoy says:

    Just had two stones removed on left side with stent insertion. 4 hours after surgery I went home. Then the hell began. Horrible spasms and pain 10 times worse than kidney stone pain. Went to ER and got stronger pain meds. Went back home and pain was back. I pulled out stent myself because it had a string attached. About 6 hours of horrible cramping then the next day pain was 50 percent less. Stay on pain meds.

  11. carla says:

    2/10/15 a 1.3mm stone got stuck in my left ureter. It was the worst pain I had ever had. The stone was pushed back into my kidney and a stent was placed. Yep, the stent is uncomfortable. On 3/13/15 I had holmium laser lithotripsy. The surgeon left multiple fragments and a new stent in place because it took too long to get it all out. I discovered that the gentle loving touch of my husband reduced my pain dramatically (seriously from and 8 to a 2)! I have used NO PAIN MEDICATIONS at all through this process. I am accepting this stent. I missed 3 days of work with the first stent. None with the second. I drink 3 L of water a day and take calcium citrate twice a day to bind the oxalate in my gut so it will pass in feces and not run through my kidneys. Calcium oxalate stones are preventable. I am on a low oxalate diet and I drink 1 lemon worth of lemonade a day. U Penn has a good list of oxalate containing foods. I am keeping the PH of my saliva and urine 6-7. Did your urologist ever tell you this is preventable???

  12. Rolf B says:

    Yesterday, I had an emergency ureteroscopy to remove a 11mm stone causing blockage. This was the worst pain I ever had for all of the stones I have had. I have had lithrotripsy about 5 times for prior stones.
    I have no issue with the stent.
    All I really wanted to say is that given the options, I would take the lithrotripsy. It was less pain and no stint to remove later. I did not have a choice yesterday. There was no lithro machines available.

    • Denise JOhnston says:

      rolf, i’m challenged with what to do i am female was in the ER 2 weeks ago with excruciating pain did CT said that i had 6mm stone. Since i have left the hospital 2 weeks ago i have had no pain, although i haven’t had any significant signs that i have passed it either… went to urologist for follow he did a KUB xray apparently it isn’t showing anything, so now doing another CT doc thinks its still in there.. have you had a stone stay in there with no issues at all?? by the way, when i was in the er the doc told me it was at its lowest point possible, meaning had to be lower of ureter getting ready to go in the bladder, there is NOTHING good i have read about this uretrescopy… have you passed a stone around that size and not noticed?
      would love your experience thoughts on this

      • Terry Yarnell says:

        Over ten years ago I had an episode where I was admitted to hospital for three days for morphine control of excruciation right flank pain. They were testing me for everything. By the time they thought about kidney stones, the pain had passed and they discharged me without diagnosis. For over ten years I had been fine. Then on Christmas Eve of this year I developed right flank pain and passing blood at the end of my urinary streams. Ultrasound showed nothing. C.T. Scan three weeks later showed 8 mm stone in right kidney. On 8 April had laser lithotripsy with basket remove. Still in recovery stage with stent in place for a few more days. I am ok on pain meds and am going back to work today. To have stent removed this coming Friday.

      • Deb says:

        Denise, what happened with your stone? Same thing happened to me, CT scan showed 6mm stone, then I had intermittent pain….now pain is gone. I have a ureteroscopy scheduled tomorrow…not sure I need it! But I did not see the stone pass.

      • tim says:

        Hello Denise I am assuming your stone issue is over by now.But I just passed a 6 mm stone on may 11. It took about 3 weeks to pass. I had a couple really painful episodes when it was in the ureter to the bladder.From the bladder on out was a piece of cake.Hope yours came out okay !!!!!!!

  13. Steve L says:

    I will be having one left-side stent removed one week after yesterday’s procedure. Very painful left kidney urination. No bleeding, though. I am a little more apprehensive about the stent removal since it will be removed through my penis.

  14. Laura says:

    I wanted to share my experince with ureteroscopy and lithrotripsy for stones in both kidneys, with stents in both kidneys. I was quite apprehensive after reading some of these posts but wanted to educate myself and be prepared for the worst going into the procedure. I had an 11 mm and 6 mm stones with multiple smaller stones in my right kidney, and an 11 mm stone with multiple smaller stones in my left kidney. I never had any kidney stone problem prior and they were only discovered when I had an xray on my back for low back pain. I had a CT scan which confiremd the stones and showed that I have medullary sponge kidney as well as a left kidney which is split in two pieces. My doctor recommended removing the stones so as not to cause future problems. This was done on 2/6/15. The procedure itself was done under general anesthesia. I woke up with a terrible headache from the anesthesia which lasted for 24 hours. I also woke up with a terrible urge to uriniate which never left for the entire week that I had the stents in. The stents were the worst part of my experience. I never passed any stones as the doctor was able to remove all of them during the procedure. And while the stents themselves were not what I would call extremely painful, they were very uncomfortable and it was difficult to sit or walk without feeling them. I had them in for a week and by the end of the week, I was at the point were I was reluctant to go to the bathroom as it caused pain to shoot up into my left kidney when urinating. My right kidney never bothered me the entrie week post procedure, but my left one did. I had a lot of discomfort in my left side. I used Percocet for the first few days, then OTC meds for the rest of the week since I had to go back to work. I had very bright red urine for 5 days afterwards, and then lighter red urine until 1 day after the stents were removed. They were removed after one week in the doctor’s office with no pain meds. It didn’t hurt at all when they were removed – all I felt was an enormous sense of relief to have them out and my symptoms of pain and discomfort cleared almost immediately. I was still a little sore and had some blood in my urine for about one more day, but then it cleared up and I have been fine since. So. my expereince probably wasn’t as bad as many of those shared on here, but I certainly don’t want to ever have to go through it again. Especially the stents part, which I have to classify as “miserable.”

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