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.

114 Responses to Ureteroscopy

  1. 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.

  2. 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
    Terry

  3. 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!!!!

  4. 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!

  5. 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.

  6. 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.

  7. 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!

  8. 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.

  9. 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.

  10. 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!!

  11. 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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