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.

291 Responses to Ureteroscopy

  1. PT says:

    I’ve recently completed this ordeal and have been thinking about leaving comments regarding my experience. I want you to keep in mind that this is a personal experience—it may very well vary depending on the person, gender, age, etc.
    Let me begin by saying that I had a kidney stone incident about 3 years ago. I experienced terrible pain in my right flank for about a week and was hospitalized but nothing ever came of it. I don’t believe I passed it but the pain lay dormant for a few years. My doctor told me this is not uncommon but I digress.
    In October of 2016, I started to notice my urine was getting dark and I felt very fatigued. I started going for X-rays and such and in November, they found that I had an 8.5 mm stone bouncing around in my right kidney. At some point, in December, it started to move into my ureter. The pain was excruciating once again so another round at the hospital and meds calmed it down. A few more attacks over the next few months and in February, I finally went for Lithotripsy shockwave therapy to try to break the stone up. It was only mildly successful but this experience was hardly a difficult one. I was put out and woke up an hour or so later in some mild discomfort but definitely manageable. Urinating hurt/burned for about two days. On my follow up visit, my specialist told me that he only managed to break a piece of it off and reduced the stone to about 6.5 mm. He wanted to try some other methods before resorting to a ureteroscopy and so we tried some other methods but in April I had another massive attack and was done with this thing. I went back in and told him to absolutely schedule me for surgery so as to remove this thing that was destroying my life.
    On Thursday, May 18, I finally went in for my ureteroscopy, nervous as all hell and not looking forward to it but with the knowledge that little else could be done to get rid of this constant pain and worry in my flank. Getting put under was an experience in and of itself—the way it is portrayed in TV and movie is quite accurate—you actually feel and hear and see everything slow to a crawl and then—OUT.
    I started to come out of it about an hour later in recover. My throat was killing me (breathing tube inserted must have scraped my insides), my mouth was VERY dry and it was incredibly hard to swallow. I remember having an immense need to urinate and the pain and burning was incredible. I told the nurse that I needed to pee or I would just piss the bed. She finally got a container for me to use and I pissed straight out blood. It was so disturbing but it did feel good to urinate though the pain and burning was next level. I was still in some shock so I remember breathing heavy and trying to get my surrounding.
    I had a stent put in as well so I had this thread hanging from my penis which every movement with it further brought on more burning and pain. Eventually, I was moved to another recovery room where I was given some juice (I can’t even describe how good it was to have some fluid down my throat—I was so parched). I urinated a few more times and was finally told I could go home.
    The next 3-4 days were horrendous. The amount of blood in my urine was very disturbing but even more so, the pain and burning was incredible. I almost broke into tears a few times because I was punching the wall in my bathroom so hard I thought I was going to break my hand. The drugs helped a bit but also constipated me which brought on another problem. It was absolutely hellish. After about 3 days, the pain started to subside but that stent was still causing me all kinds of grief.
    I finally had the stent removed yesterday (5 days after the procedure), which was another crazy experience. It felt like it would never end coming out—I felt like one of those magician props where the handkerchief continues to come out of a sleeve…funny now, but not so funny at the time. The good news is after about 10-20 seconds, that is over. It was almost instant relief though the rest of the day, I had kidney and bladder spasms which a little more pain med took care of.
    It is now the day after stent removal and I feel much better. I’m so happy I got this thing taken out but what an experience. My heart goes out to anyone who has to go through this. I did so much research on the net (though there really isn’t that much out there) but doing it first hand was another thing entirely.
    Good luck!

  2. Jim Nealis says:

    I had a ureteroscopy on Friday, May 5th – in both kidneys since I had 4 stones in one, 5 in the other. I was unconscious during the entire procedure, but awoke to discover I had a catheter that would be in me for three days, which was quite uncomfortable. I think it was because I have enlarged prostate problems, so Dr. thought it would help me urinate better, which it did. I had no pain whatsoever after the procedure. On Monday, May 8th, the catheter and ureter stents were removed. I felt great – but driving home from the removal, I felt a pain in my back (right kidney) area. It got so bad that when I reached my driveway I got out of my car and vomited. I had the oxycodone pills the Dr. had prescribed, still unopened on my table. I got one and pain slowly subsided after 45 mins. I contacted the Dr. – he said it was a typical post-stent removal spasm. I needed a mix of oxy and Ibuprofen the next few days. It is now May 15th – that pain is basically gone – but ten days after the procedure I still have lots of blood in my urine, which concerns me. Also, it still hurts a bit to urinate, thought probably due to my prostate. While the procedure went smoothly, the aftermath has been more than I expected.

  3. Stuey says:

    I’ve got to have this done soon, I am now really nervous as whilst the kidney stone pain has been excruciating, it seems it gets worse with the procedure from people’s experience ?

  4. Olivia Young says:

    I am 19 years old and I have just had this done on Friday 28th April, I had this to remove stones that trapped in my bladder passage I still have 6mm stones stuck in my kidney that will need further treatment. 2 years ago when I was 17 I had keyhole surgery to remove a kidney stone from my kidney called a staghorn calculus I had a stent placed in afterwards. The stent caused me numerous amount of pain and luckily this time I requested not to have one in and the surgeon didn’t need to put one in. I feel really poorly from this I am stuck in bed as I just have pain in my right side kidney and going to the toilet is so painful! I hope this is normal for a while? I am scared to go to the toilet! Does anyone know of any good painkillers or remedies that make you feel better? I am on ciprofloxacin antibiotics and I have just been given ibuprofen but these defiantly didn’t help my pain!

  5. I had this ureteroscopy done in Feb of 2017 for a three mm stone that was causing quite a lot of back. My lower back still hurts off on and the leg does too. Maybe they hit a nerve when they put the in I don’t know.

  6. Mary Ritchie says:

    This is a painful barbaric procedure. This so call small scope is inserted into your Urethra [hole you pee out]….Ohhh didn’t realize well, take a look at that so called ‘small’ camera. Surgery went seemingly well, then at home take Motrin, call Dr oh well thats why we gave you Oxicodone in case the pain intensified. Take the Oxi and Motrin. Every time you urinate its burning / painful and you go a great deal because of the stint. Three days with the stint and they lead you to believe it will all be over on day 3…Frig no! The stint comes out…they describe a small tube that allows the Ureter and surgical area to heal….they forget to tell you about the small coils holding it in place. Now with NO ANESTHESIA they place the scope back in your already tender urethra and remove the stint…as the coil uncoils and stint removed it creates further irritation. This ‘Irritation’ subsides in a day or so…. Well they omit telling you about the SEVERE cramping and pain like a horse has kicked your kidney that causes nausea and vomiting. Pain like you never had in life, Doctor just take the Motrin. Nausea, pain take Motrin now you vomit and that continues for hours until you end up in the ER……. Incision vs this torture…..INCISION!

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