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.

146 Responses to Ureteroscopy

  1. 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???

  2. 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.

  3. 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.

  4. 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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