Ureteroscopy & Laser Kidney Stone Surgery
Ureteroscopy is a minimally invasive approach used to treat selected stones in the ureter and kidney. Fine telescopes are passed through the natural urinary tract to reach the stone, allowing it to be fragmented with laser energy or removed directly when appropriate.
Fever or significant illness with an obstructing stone needs urgent assessment
Infection behind a blocked kidney can be a urological emergency. Seek urgent medical assessment if stone symptoms occur with fever, chills or rigors, significant illness, difficulty passing urine or concerning deterioration.
What is ureteroscopy?
Ureteroscopy involves passing a fine telescope through the urethra, bladder and into the ureter. This provides direct access to selected urinary stones without making an external skin incision.
A semi-rigid ureteroscope can be used for many stones within the ureter. A flexible ureteroscope can travel further through the urinary tract and into the collecting system of the kidney.
Flexible endoscopic treatment within the kidney may also be described as flexible pyeloscopy, flexible ureteroscopy or retrograde intrarenal surgery (RIRS).
Which stones can be treated with ureteroscopy?
Ureteroscopy can be used for many ureteric stones requiring active treatment and for selected stones inside the kidney. Suitability depends on the complete clinical situation rather than stone size alone.
Ureteric Stones
Stones lodged between the kidney and bladder can often be reached directly using a ureteroscope when active removal is required.
Explore ureteric stones →Selected Kidney Stones
Flexible ureteroscopy can reach stones within many areas of the kidney collecting system and may be suitable for selected renal stone burdens.
Impacted Upper Ureteric Stones
A stone that has remained lodged within the upper ureter may require more detailed planning because the surrounding ureter can become inflamed or narrowed.
Explore impacted stones → 04 • Active TreatmentStones Unlikely to Pass
Treatment becomes more relevant when a stone has a low likelihood of spontaneous passage or continues to cause pain, obstruction or other complications.
When does a stone need surgery? → 05 • Previous TreatmentResidual Kidney Stones
Flexible ureteroscopy may sometimes be used for residual stones or fragments that remain following previous stone treatment.
Explore residual stones → 06 • Staged TreatmentSelected Larger Stone Burdens
Ureteroscopy can sometimes form part of a staged strategy, although larger or more complex kidney stones may be better suited to PCNL.
Explore complex kidney stones →How does ureteroscopy and laser stone treatment work?
The exact operation depends on stone position, urinary anatomy and what is found during surgery. A typical ureteroscopic procedure involves four main stages.
Access the Urinary Tract
A telescope is passed through the urethra and bladder toward the ureter. There is normally no external skin incision.
Reach the Stone
A semi-rigid or flexible ureteroscope is advanced toward the position of the stone identified on imaging.
Treat the Stone
Laser energy may fragment or dust the stone. Selected fragments can also be removed using a small endoscopic basket.
Assess Drainage
A temporary ureteric stent may be inserted when additional drainage or ureteric recovery is considered helpful.
Laser lithotripsy
A fine laser fibre is passed through the working channel of the ureteroscope and positioned against the stone under direct endoscopic vision.
The aim may be to divide the stone into removable fragments or progressively reduce it into much smaller particles.
The exact laser settings and treatment strategy are selected according to the stone and operative circumstances.
What does the laser actually do?
Laser energy allows a stone to be treated under direct vision through the ureteroscope rather than relying on externally delivered energy.
Depending on the stone, treatment may focus on producing larger fragments for basket removal, progressively reducing the stone into smaller particles, or using a combination of techniques.
The stone can be divided into smaller pieces suitable for retrieval where appropriate.
Selected stones can be progressively reduced into much smaller particles intended to clear through the urinary tract.
Small endoscopic baskets can be passed through the ureteroscope to retrieve selected stone fragments.
The surgeon can see the stone and surrounding urinary tract during treatment.
Treatment planning starts with the stone itself
Ureteroscopy is not selected simply because a kidney stone is present. CT findings, symptoms, obstruction, infection risk and urinary anatomy help determine whether it is an appropriate treatment.
Urine testing is particularly important before endoscopic stone surgery. If significant infection is present behind an obstructed kidney, urgent drainage may be required before definitive stone removal is undertaken.
Will I need a ureteric stent?
Not necessarily. A ureteric stent is commonly used in selected situations, but a postoperative stent is not automatically required after every uncomplicated ureteroscopy.
The stent decision depends on what happens during surgery
A ureteric stent is a thin temporary internal tube extending from the kidney to the bladder. It can maintain drainage while swelling settles or the ureter recovers.
When ureteroscopy has been uncomplicated and drainage is satisfactory, postoperative stenting may sometimes be avoided.
Ureteric Stents – What to Expect
What should I expect after ureteroscopy?
Recovery varies according to the complexity of the procedure, stone burden, anaesthetic, individual health and whether a ureteric stent is present.
Many ureteroscopic procedures can be performed as day surgery or with a short hospital stay, although this depends on the operation and individual clinical circumstances.
Temporary burning, urinary frequency or urgency can occur after instrumentation of the urinary tract.
Some visible blood or pink urine can occur following ureteroscopy, particularly when a ureteric stent is present.
Frequency, urgency, bladder discomfort or flank discomfort can occur until the stent is removed.
Follow-up may include stent removal, review of stone analysis and imaging to assess residual stone or confirm urinary drainage.
What are the risks of ureteroscopy?
Ureteroscopy is an established endoscopic stone procedure, but all surgery has potential risks. Their relevance depends on the stone, urinary anatomy, infection risk and individual circumstances.
Occasionally the safest approach is to stop the procedure, insert a temporary stent and return at another time rather than force access through a tight or inflamed ureter.
A substantial kidney stone burden may also be better approached using PCNL or treatment performed in stages.
Why might more than one procedure be needed?
The aim of ureteroscopy is safe stone treatment rather than attempting complete clearance at any cost.
If the ureter is too narrow for safe access, a temporary stent may be inserted and ureteroscopy performed later. This allows the ureter time to accommodate the instruments without forcing access.
Larger stone burdens, difficult kidney anatomy, poor visibility or multiple stones can also make treatment in stages safer or more appropriate.
Is ureteroscopy always the best treatment?
No. The appropriate treatment depends on the stone rather than assuming that every kidney or ureteric stone should be treated in the same way.
Related kidney stone information
These pages address common questions before and after ureteroscopy and connect this procedure with your wider kidney stone treatment pathway.
Ureteroscopy & laser surgery FAQs
Is ureteroscopy the same as laser kidney stone surgery?
Ureteroscopy describes passing the telescope into the urinary tract. Laser lithotripsy is one method that can then be used through the telescope to fragment or dust the stone. The terms are therefore frequently used together.
What is flexible pyeloscopy?
Flexible pyeloscopy uses a flexible ureteroscope to examine and treat stones within the kidney collecting system. It may also be described as flexible ureteroscopy or retrograde intrarenal surgery.
Does ureteroscopy involve an external incision?
Ureteroscopy is normally performed through the natural urinary tract and therefore usually does not require an external skin incision.
Will the entire kidney stone be removed?
Some stones can be removed as fragments, while others are fragmented or reduced into smaller particles. Complete stone clearance during a single operation is not always possible, particularly with larger stone burdens or difficult anatomy.
Will I definitely need a ureteric stent?
No. A postoperative ureteric stent is not required following every uncomplicated ureteroscopy. The decision depends on access, ureteric swelling, operative findings, residual fragments and drainage requirements.
Why might ureteroscopy need to be performed in two stages?
Occasionally the ureter is too narrow or inflamed for safe access during the first operation. In that situation, placing a temporary stent and returning later can be safer than forcing the ureteroscope through a resistant area.
Can ureteroscopy treat a large kidney stone?
Flexible ureteroscopy can treat many kidney stones, but increasing stone size and complexity can make PCNL more appropriate. Larger stone burdens may also require staged treatment if ureteroscopy is selected.
Can I undergo ureteroscopy if I have a urine infection?
Infection is an important consideration before stone surgery. Active infection may require treatment before definitive ureteroscopy. Significant infection behind an obstructed kidney may instead require urgent urinary drainage before the stone itself is treated.
How long does recovery take?
Recovery varies with the complexity of the operation, individual health and whether a ureteric stent is present. Return-to-work, driving and exercise advice should be based on the specific procedure performed and individual recovery.
Can kidney stones come back after ureteroscopy?
Yes. Ureteroscopy treats the existing stone but does not necessarily remove the underlying tendency to form future stones. Selected recurrent stone formers may benefit from stone analysis, blood testing and metabolic assessment including a 24-hour urine collection.
Clinical information
This page provides general patient information about ureteroscopy and laser stone surgery. Clinical management should be individualised according to stone characteristics, urinary anatomy, obstruction, infection, kidney function, previous procedures, medical conditions and patient circumstances.
- European Association of Urology. EAU Guidelines on Urolithiasis. Current edition.
- American Urological Association. Surgical Management of Kidney and Ureteral Stones: AUA Guideline. Current edition.
Have you been told you may need ureteroscopy or laser stone surgery?
Existing CT imaging and investigations can be reviewed alongside your symptoms and stone history to determine whether ureteroscopy is appropriate or whether observation, shock-wave treatment, PCNL or another pathway may be more suitable.