Ureteroscopy & Laser Kidney Stone Surgery
Ureteroscopy is a minimally invasive approach to selected kidney and ureteric stones. Fine telescopes are passed through the natural urinary tract to reach the stone, which can then be removed or fragmented using laser energy.
What is ureteroscopy?
Ureteroscopy involves passing a fine telescope through the urethra and bladder and then into the ureter. This allows the urinary tract to be examined and selected stones to be treated without a skin incision.
A rigid ureteroscope may be used for some stones within the ureter. A flexible ureteroscope can travel further into the kidney collecting system and is commonly used to treat selected kidney stones.
Flexible endoscopic treatment inside the kidney may also be described as flexible pyeloscopy or retrograde intrarenal surgery (RIRS).
What stones can be treated with ureteroscopy?
Whether ureteroscopy is appropriate depends on the location, size and characteristics of the stone as well as the patient's individual circumstances.
Ureteric Stones
Stones lodged within the ureter can often be reached directly with a ureteroscope and treated endoscopically.
Kidney Stones
Flexible ureteroscopy can reach selected stones within the kidney collecting system.
Stones Unlikely to Pass
Intervention may be considered when a ureteric stone is unlikely to pass spontaneously or is causing persistent symptoms or obstruction.
Persistent Stone Pain
Ongoing renal colic despite appropriate initial management may be a reason to consider active stone treatment.
Residual Stones
Ureteroscopy may sometimes be used to treat remaining stones after previous stone treatment.
Individual Treatment Planning
Stone density, kidney anatomy, previous procedures and patient circumstances can all influence whether ureteroscopy is suitable.
How does ureteroscopy and laser stone treatment work?
The exact procedure varies according to the location and complexity of the stone, but the general pathway involves four main steps.
Access the Urinary Tract
A telescope is passed through the urethra and bladder to reach the ureter. There is usually no external skin incision.
Reach the Stone
A rigid or flexible ureteroscope is advanced to the area where the stone is located.
Treat the Stone
Laser energy can be delivered through a fine fibre to fragment or dust the stone. Selected fragments may also be removed.
Drainage if Required
A temporary ureteric stent may be inserted when additional drainage or ureteric healing is considered helpful.
What does the laser do?
A fine laser fibre can be passed through the ureteroscope and positioned directly against the stone.
Laser energy is then used to break the stone into smaller fragments or to progressively reduce it into much smaller particles. The technique used depends on the stone and the treatment objective.
Some fragments may be retrieved using small endoscopic baskets, while sufficiently small fragments may be left to pass naturally.
- Direct visualisation of the stone
- Laser fragmentation or dusting
- Endoscopic removal of selected fragments
- Access to ureteric and selected renal stones
Will I need a ureteric stent?
A stent is commonly used in selected circumstances after ureteroscopy, but it is not required after every uncomplicated procedure.
What is a stent?
A ureteric stent is a thin temporary tube positioned internally between the kidney and bladder. It can help maintain urine drainage while swelling settles after a procedure.
The decision to place a stent depends on what was found and performed during surgery.
Learn about ureteric stentsWhat can a stent feel like?
Stents can cause temporary urinary frequency, urgency, bladder discomfort, blood in the urine or discomfort in the kidney region, particularly during or after urination.
The timing and method of stent removal varies according to the reason it was inserted and the individual procedure.
What should I expect after ureteroscopy?
Recovery varies according to the complexity of the procedure, the stone burden and whether a ureteric stent has been inserted.
Many patients can leave hospital on the day of surgery or following a short hospital stay, although this depends on the procedure and individual circumstances.
Urinary Discomfort
Mild burning or urinary frequency can occur for a short period after instrumentation of the urinary tract.
Blood in the Urine
Some blood in the urine can occur following ureteroscopy and may also occur while a ureteric stent remains in place.
Stone Clearance
Follow-up depends on the stone and procedure and may include imaging to assess residual fragments or confirm drainage.
What are the risks of ureteroscopy?
Ureteroscopy is a commonly performed endoscopic stone procedure, but all surgery carries potential risks. These should be considered in the context of the stone being treated and the alternatives available.
Why might more than one procedure be needed?
The goal is to treat the stone safely. With a larger stone burden, difficult anatomy, poor visibility or limited access, it may not be appropriate to attempt complete stone clearance during a single procedure.
Occasionally a stent is placed and ureteroscopy is completed at a later procedure after the ureter has had time to accommodate the instruments.
Larger or more complex kidney stones may instead be better treated using another approach such as PCNL.
Learn About PCNLWhen should I seek urgent medical attention after stone surgery?
Seek urgent medical assessment if you become significantly unwell, particularly with fever or chills, worsening severe pain, persistent vomiting, difficulty passing urine or other concerning symptoms after a stone procedure. Follow the specific discharge instructions provided by your treating team.
Is ureteroscopy always the best treatment?
No single stone treatment is best for every patient. Stone size, location and complexity help determine which treatment options are appropriate.
Kidney Stones
Learn about symptoms, diagnosis, observation and the main kidney stone treatment pathways.
PCNL
Percutaneous nephrolithotomy is an important treatment option for selected larger or more complex kidney stones.
Recurrent Kidney Stones
Find out about investigation and strategies aimed at reducing the risk of future stone formation.
Ureteroscopy & Laser Surgery FAQs
Is ureteroscopy the same as laser kidney stone surgery?
Ureteroscopy refers to passing the telescope into the urinary tract. Laser energy is one method used through that telescope to fragment the stone. The terms are therefore often used together when describing endoscopic stone treatment.
What is flexible pyeloscopy?
Flexible pyeloscopy uses a flexible ureteroscope to examine and treat stones within the kidney collecting system. The procedure may also be described as flexible ureteroscopy or retrograde intrarenal surgery.
Does ureteroscopy involve an incision?
Ureteroscopy is normally performed through the natural urinary tract and therefore usually does not require an external skin incision.
Will the laser damage my kidney?
Laser energy is delivered through a fine fibre under direct endoscopic vision and is directed at the stone. As with any surgical procedure, there are potential risks, which should be discussed in the context of the planned treatment.
Will the entire stone be removed?
Some stones can be removed as fragments while others are fragmented or dusted into smaller particles. Complete clearance during one procedure is not always possible, particularly with a larger stone burden or difficult anatomy.
Will I definitely need a stent?
No. A ureteric stent is not required after every uncomplicated ureteroscopy. The decision depends on factors such as ureteric swelling, access, residual fragments and what occurred during the procedure.
Can ureteroscopy treat a large kidney stone?
Ureteroscopy can treat many kidney stones, but increasing stone size and complexity can make other approaches more suitable. PCNL is an important treatment option for selected larger renal stones.
Can I have ureteroscopy if I have a urine infection?
Infection is an important consideration before stone surgery. Urine testing is commonly performed before treatment, and an active infection may need to be treated before definitive stone surgery. An infected obstructed urinary system may instead require urgent drainage.
How long does recovery take?
Recovery varies with the complexity of surgery and whether a stent has been inserted. Some patients experience temporary urinary frequency, discomfort or blood in the urine following the procedure. Individual return-to-work and activity advice should be based on the procedure performed and your recovery.
Can kidney stones come back after surgery?
Yes. Removing a stone does not necessarily remove the underlying tendency to form stones. Patients with recurrent stone disease may benefit from further investigation and an individual prevention strategy.
Have you been told you may need ureteroscopy or laser stone surgery?
Existing imaging can be reviewed alongside your symptoms and clinical history to determine whether ureteroscopy is suitable or whether observation, PCNL or another stone treatment pathway may be more appropriate.
This information is general educational information and does not replace individual medical advice. The appropriate treatment for urinary stones depends on factors including stone size and location, symptoms, obstruction, infection, kidney function, urinary anatomy, previous treatment and individual clinical circumstances.