Ureteroscopy (URS)

Introduction

If your doctor has told you that you need ureteroscopy — often shortened to URS — you are probably dealing with a kidney stone, a ureteric stone, or another problem in the tubes that carry urine from your kidneys to your bladder. URS is one of the most commonly performed procedures in urology today, and for many patients it has replaced larger, more invasive operations.

This guide explains what ureteroscopy is, why it is performed, what happens before, during, and after the procedure, and what life looks like during recovery. It also covers the ureteral stent that many patients have placed at the end of the procedure — one of the most common sources of questions during the recovery period.

The aim is to give you a clear picture of the journey so that conversations with your urologist are easier, and so you know what to expect at each step.

What Is Ureteroscopy (URS)?

Ureteroscopy is an endoscopic procedure. That means a thin tube with a camera and a light, called a ureteroscope, is passed into the body through a natural opening — in this case, the urethra (the tube that carries urine out of the body). The scope travels up through the urethra into the bladder, and then up the ureter (the tube between the bladder and the kidney). When needed, a flexible version of the scope can be steered into the kidney itself.

Because the scope uses the body’s natural urinary passage, no cut is made on the skin. This is what makes URS a minimally invasive procedure.

URS is most often performed to:

• Remove or break up stones lodged in the ureter
• Treat small to medium-sized stones inside the kidney
• Investigate narrowed areas of the ureter, called strictures
• Look at suspicious areas or tumours in the lining of the upper urinary tract
• Help find the cause of unexplained blood in the urine
• Take a small tissue sample (biopsy) if needed

When URS is used mainly to look inside the urinary tract, it is sometimes called diagnostic ureteroscopy. When it is used to treat a stone or other problem, it is called therapeutic ureteroscopy. In practice, the same procedure often does both: the urologist inspects, finds the problem, and treats it in the same session.

How URS Differs from Other Stone Procedures

Three procedures are most commonly used to treat kidney and ureteric stones, and they each have their place. Major urology societies, including the American Urological Association (AUA) and the European Association of Urology (EAU), describe them as complementary rather than competing options:

• Extracorporeal Shock Wave Lithotripsy (ESWL) uses shock waves from outside the body to break stones. There is no instrument inside the body. It works best for smaller stones in certain positions.
• Ureteroscopy (URS) uses a scope passed through the natural urinary passage. Stones are broken up with a laser or grasped directly. No skin incision is made.
• Percutaneous Nephrolithotomy (PCNL) involves a small cut in the back to pass an instrument directly into the kidney. It is usually used for larger or more complex stones.

Which procedure suits a particular patient depends on the size, location, and hardness of the stone, the anatomy of the urinary tract, and other clinical factors. URS has become one of the most widely used options for stones in the ureter and for many small to medium kidney stones.

Why Is Ureteroscopy Performed?

Most patients are offered URS because of a stone that needs to be removed or broken up. Common reasons your urologist may recommend the procedure include:

• A stone that is too large to pass on its own
• A stone causing persistent pain, infection, or fever
• A stone blocking the flow of urine and causing the kidney to swell (hydronephrosis)
• A stone that has not passed after a period of waiting and medical treatment
• Stones in patients with a single kidney, where any blockage is more risky
• Stones in patients who cannot wait for stone passage because of work, travel, or other medical reasons
• Stones that did not break adequately with shock wave therapy

Beyond stones, URS may also be used when imaging shows a narrowing in the ureter, when there are abnormal cells in the urine, or when blood is seen in the urine without a clear cause from earlier tests.

Who Is a Candidate?

Most adults with stones in the ureter, and many with small or moderately sized stones in the kidney, are suitable candidates for URS. Your urologist will consider:

• Stone size and location. URS works very well for stones in the middle and lower ureter, and increasingly well for stones in the upper ureter and kidney thanks to modern flexible scopes and lasers.
• Stone composition. Some stones are very hard. Laser lithotripsy used during URS can break most stone types, but harder stones may take longer or need a staged approach.
• Anatomy. A narrow ureter, previous surgery, or unusual anatomy may make access difficult. In some cases, a stent is placed first to gently widen the ureter before the main procedure.
• Active infection. If there is an untreated urinary infection, the stone procedure is usually postponed and antibiotics are given first. Operating on an infected, obstructed system can be dangerous.
• Bleeding risk. Patients on blood thinners may need a plan to pause or adjust those medicines around the procedure.
• Pregnancy. URS can be performed in pregnancy when necessary, but the approach is carefully tailored and radiation use is minimised.
• Other health conditions. Heart, lung, and kidney health are assessed because the procedure usually requires anaesthesia.

Alternatives to Ureteroscopy

URS is one of several options for kidney and ureteric stones. Whether it is the right option for any specific patient is a clinical decision made with the urologist after looking at imaging and the overall picture.

Watchful Waiting and Medical Expulsive Therapy

Small stones — typically those less than around 5 to 6 mm — often pass on their own with hydration, pain control, and sometimes a medicine called an alpha-blocker that relaxes the ureter. This is known as medical expulsive therapy. Doctors usually consider this approach when the stone is small, the patient is comfortable, there is no infection, and kidney function is preserved.

Extracorporeal Shock Wave Lithotripsy (ESWL)

ESWL uses focused shock waves delivered from outside the body to break the stone into small pieces that then pass in the urine. It is non-invasive and usually does not need a hospital stay. It works best for smaller stones in certain positions and for stones that are not too hard.

Percutaneous Nephrolithotomy (PCNL)

PCNL is generally used for larger kidney stones (commonly more than 2 cm) or complex stone configurations such as staghorn stones. A small puncture is made in the back to reach the kidney directly. It is more invasive than URS but more effective at clearing large stone burdens in one session.

Open or Laparoscopic Stone Surgery

Open or laparoscopic surgery for stones is uncommon today. It is reserved for very complex situations where endoscopic and percutaneous approaches are not suitable.

Your urologist will discuss which approach — or combination of approaches — fits your specific stone burden, anatomy, and overall health.

Types and Approaches in Ureteroscopy

Ureteroscopy is not a single fixed procedure. Several variations are used depending on where the stone is and what needs to be done.

Semi-Rigid Ureteroscopy

A semi-rigid scope is straight and is used mainly to reach stones in the lower and middle ureter, and sometimes the upper ureter. It gives a clear view and allows the use of small instruments to grasp or break stones.

Flexible Ureteroscopy

A flexible scope can bend and be steered around curves. This makes it possible to reach the upper ureter and the inside of the kidney. Flexible URS used to treat stones inside the kidney is sometimes called retrograde intrarenal surgery, or RIRS.

Laser Lithotripsy

During URS, a thin laser fibre is passed through a channel in the scope. The Holmium:YAG laser has been the long-standing standard, and newer thulium fibre lasers are increasingly used in many centres. The laser breaks the stone into tiny fragments or dust that can either be removed with a small basket or passed naturally in the urine.

Diagnostic Ureteroscopy

When the goal is to investigate — for example, to look at an area of narrowing, to evaluate suspicious cells, or to find the source of blood in the urine — the scope is used primarily to inspect the lining of the urinary tract. Small biopsies can be taken if needed.

Combined Procedures

In some situations, URS is combined with other techniques. For example, a stent may be placed first to allow the ureter to relax before a planned URS. Or URS may be performed alongside PCNL in cases of complex stones (a combined approach sometimes called ECIRS).

Preparing for Ureteroscopy

Preparation for URS usually involves several steps in the days and weeks before the procedure.

Tests and Imaging

Your urologist will typically arrange:

• Urine tests to check for infection. Any infection is usually treated with antibiotics before the procedure.
• Blood tests to check kidney function, blood counts, and clotting.
• Imaging. A non-contrast CT scan of the urinary tract is the most accurate way to see stones and is widely used to plan URS. Ultrasound and X-rays may also be used.
• Anaesthesia review. An anaesthetist will review your medical history and medicines.

Medicines

You will be asked about all medicines you take. Blood-thinning medicines (such as aspirin, clopidogrel, warfarin, or direct oral anticoagulants) often need to be paused or adjusted. Do not stop any prescribed medicine without medical advice.

Fasting

You will usually be asked not to eat or drink for several hours before the procedure. The exact instructions depend on the type of anaesthesia planned and the time of your surgery.

What to Bring and Arrange

• Loose, comfortable clothing for after the procedure
• A list of your medicines and allergies
• Someone to take you home if you are discharged the same day
• Time off work and rest at home for the first few days

What Happens During Ureteroscopy

URS is usually performed in an operating theatre under general anaesthesia (you are fully asleep) or spinal anaesthesia (numb from the waist down). The choice depends on the case and on patient preference where appropriate.

Step by Step

1. Anaesthesia. Once you are asleep or numb, you are positioned on the operating table, usually with the legs gently raised in stirrups.
2. Bladder access. A cystoscope or the ureteroscope itself is passed through the urethra into the bladder. No cut is made.
3. Reaching the ureter. A thin guidewire is gently passed up the ureter, often under X-ray guidance, to mark a safe path.
4. Inserting the ureteroscope. A semi-rigid or flexible scope is then passed along this path. In some cases, a thin tube called a ureteral access sheath is placed first to help the scope go in and out smoothly, especially for kidney stones.
5. Locating the problem. The urologist looks for the stone, stricture, or area of concern.
6. Treating the stone. If a stone is found, it is either grasped with a small basket and removed, or broken up using a laser fibre. The fragments may be removed with a basket or left to pass naturally.
7. Inspection. The urologist checks the ureter and kidney for any injury, remaining fragments, or other findings.
8. Stent placement. In many cases, a thin, soft tube called a ureteral stent is placed inside the ureter at the end of the procedure (see next section).
9. Recovery. The scope is removed and you are moved to the recovery area.

The Ureteral Stent

Stents are commonly placed after URS because:

• The ureter may be swollen after the procedure
• Stone fragments need a clear path to pass
• Drainage from the kidney needs to be protected

Not every patient needs a stent. Whether one is used depends on the stone, the procedure, and the urologist’s judgement. When a stent is used, it usually stays in place for about one to two weeks, but the exact duration is decided by your urologist. Removal is a quick outpatient process, usually done in the clinic without a major anaesthetic.

Recovery and Healing

The First Few Days

It is normal to experience:

• Mild burning or stinging when passing urine
• Pink or light red urine for a few days
• A feeling of urinary urgency or needing to go often
• Mild discomfort in the lower abdomen, side, or back
• Tiredness from the anaesthesia

Drinking plenty of water helps flush the urinary tract and helps any small stone fragments pass.

Living with a Stent

If a stent has been placed, you may notice symptoms specifically related to it. These are common and usually settle once the stent is removed. They include:

• A pulling sensation in the lower back or flank when passing urine
• More frequent urination
• Mild blood in the urine, especially after activity
• Discomfort in the bladder area

Your urologist will give you a clear plan for when the stent will be removed. It is important to keep this appointment — stents are not designed to be left in indefinitely and can cause problems if forgotten.

Activity and Work

Light activity is usually encouraged from the day after the procedure. Walking helps recovery. Heavy lifting, strenuous exercise, and contact sports are generally avoided for at least one to two weeks, or as advised by your surgeon. Many patients return to office-based work within a few days. Physically demanding work may need a longer break.

Diet and Fluids

Most patients are encouraged to drink enough water to keep urine pale in colour. There are usually no major food restrictions, although your urologist may suggest dietary changes later once the type of stone is known.

Follow-Up

Follow-up usually includes:

• A clinic visit one to two weeks after the procedure
• Stent removal, when needed
• Imaging (such as an ultrasound, X-ray, or low-dose CT) to confirm stone clearance and check that the kidney is draining well
• Stone analysis if fragments were collected, which helps guide prevention

Risks and Complications

URS is considered a safe procedure in experienced hands, but no procedure is free of risk. Most complications are minor and resolve with simple treatment. Possible risks include:

• Urinary tract infection. Antibiotics are usually given around the procedure to reduce this risk.
• Bleeding. Mild blood in the urine is common and settles on its own. Heavier bleeding is uncommon.
• Stent-related discomfort. As described above.
• Ureteric injury. Small abrasions of the lining are not unusual and heal on their own. More serious injury, such as a tear or perforation, is uncommon but can require additional treatment, including a longer period of stenting or, rarely, further surgery.
• Ureteric stricture. A narrowing of the ureter can develop later in a small number of patients, particularly after difficult or repeated procedures. This is one reason follow-up imaging is important.
• Residual stone fragments. Small fragments may remain after the procedure. Most pass naturally, but sometimes a second procedure is needed.
• Sepsis. A serious, body-wide reaction to infection is uncommon but can occur, especially if there was infection before the procedure. This is a key reason urologists treat infections before operating.
• Anaesthesia risks. As with any procedure under anaesthesia.

Warning signs after going home include high fever, severe pain that is not relieved by prescribed medicines, heavy bleeding, vomiting that prevents fluid intake, or inability to pass urine. You should contact your urology team or seek urgent care if any of these occur.

Success Rates and Outcomes

URS has high success rates for treating stones in the ureter and many kidney stones. Stone-free rates — meaning no stone fragments are seen on follow-up imaging — are commonly reported in the 90% and above range for ureteric stones, and somewhat lower but still favourable for kidney stones, depending on stone size, hardness, and location. Major society guidelines (AUA, EAU) describe URS as a first-line or strongly considered option for most ureteric stones and for many kidney stones up to around 2 cm.

For larger or more complex stones, more than one session may be needed, or URS may be combined with another approach.

Specific outcomes depend on individual factors, and your urologist can give a more personalised estimate based on your imaging and overall situation.

Life After Ureteroscopy

For most patients, life returns to normal within a week or two of the procedure, and within a few days of stent removal if a stent was placed. The longer-term focus shifts from the procedure itself to preventing new stones.

Preventing Stone Recurrence

Once a person has had a kidney stone, the risk of forming another is meaningful over a lifetime. Stone prevention is one of the most useful things to take from the URS journey.

Common prevention strategies include:

• Hydration. Drinking enough fluid to keep urine pale — commonly around 2 to 3 litres a day, adjusted for climate and activity — is one of the strongest preventive steps.
• Dietary review. Depending on stone type, advice may include lowering salt intake, moderating animal protein, ensuring adequate dietary calcium (rather than restricting it), and reducing oxalate-rich foods for some stone types.
• Weight management. Obesity and metabolic syndrome are linked to higher stone risk.
• Treating underlying conditions. Conditions such as gout, certain bowel disorders, or hyperparathyroidism may need separate management.
• Metabolic evaluation. For recurrent or unusual stones, a 24-hour urine collection and other tests can identify specific imbalances that can be treated with diet or medication.
• Stone composition analysis. Sending any retrieved stone fragments for analysis helps tailor prevention.

Follow-Up Imaging

Some patients have periodic imaging to check for new or recurring stones, especially if they have a strong history of stone formation. The frequency depends on individual risk.

Ureteroscopy in Children

Stone disease in children has become more common in recent years. URS is increasingly used as a treatment option for children with ureteric and kidney stones, alongside ESWL and, for larger stones, paediatric PCNL.

Important points for parents include:

• Specialised care. URS in children is usually performed by paediatric urologists or by adult urologists with specific paediatric experience, using smaller scopes and instruments designed for children.
• Anaesthesia. The procedure is performed under general anaesthesia in children.
• Stents. If a stent is placed, removal in younger children usually requires another brief anaesthetic, because the procedure is not well tolerated awake at younger ages.
• Underlying causes. Stones in children more often have an underlying metabolic or anatomical cause. A detailed evaluation after the procedure is important to guide long-term prevention.
• Recovery. Children generally recover quickly, but follow-up and prevention are particularly important to reduce the lifetime risk of recurrent stones.

Frequently Asked Questions

Is ureteroscopy painful?

You should not feel pain during the procedure because of the anaesthesia. After the procedure, most patients feel mild discomfort that is managed with simple pain medicines. Stent-related symptoms can cause more bother for some patients until the stent is removed.

How long does ureteroscopy take?

Most procedures take between 30 and 90 minutes. The exact time depends on the stone’s size, location, and how easy the ureter is to access.

How long will I stay in hospital?

Many patients are discharged the same day. Others stay one night, particularly if the procedure was longer, more complex, or if there is a need for observation.

Will I definitely need a stent?

Not always. Stents are commonly placed but not in every case. Your urologist will decide based on the procedure performed, the condition of the ureter, and whether the stone was fully cleared.

How is the stent removed?

Stent removal is usually a quick outpatient procedure. A thin scope is passed through the urethra into the bladder, the stent is grasped, and it is gently pulled out. In adults this is often done with local anaesthetic gel. In young children, a brief general anaesthetic is typically used.

Why does my urine look pink after the procedure?

Light pink or red urine for a few days is normal after URS. It happens because the lining of the urinary tract has been worked on. Drinking plenty of water helps. Heavy bleeding, large clots, or bleeding that gets worse should be reported to your urology team.

When can I go back to work?

Many people with office-based jobs return within a few days. Physically demanding work may need one to two weeks, and sometimes longer if a stent is in place. Follow your surgeon’s specific advice.

Can stones come back after URS?

Yes. URS treats the current stone but does not prevent new stones from forming. Lifelong attention to hydration, diet, and any underlying causes is the main way to reduce that risk.

Can ureteroscopy damage the kidney?

Serious damage is uncommon. Minor abrasions of the ureter usually heal on their own. Long-term kidney problems specifically caused by URS are unusual when the procedure is performed by experienced urologists and followed up properly.

What is the difference between URS and RIRS?

Retrograde intrarenal surgery (RIRS) is a form of flexible ureteroscopy used to treat stones inside the kidney. It uses the same overall principle as URS — reaching the urinary tract through the natural passage — but with a flexible scope steered into the kidney and a laser used to break stones there.

Conclusion

Ureteroscopy is a minimally invasive, well-established procedure for treating most stones in the ureter and many stones in the kidney, as well as for investigating problems in the upper urinary tract. It avoids skin incisions, usually allows a short hospital stay, and offers high stone-clearance rates when performed by experienced urologists.

The procedure itself is only one part of the journey. Understanding why URS was offered, what happens during recovery (particularly with a stent), and how to reduce the risk of new stones over time gives you the best chance of a smooth recovery and good long-term urinary health. The specifics of your case — the size and location of your stone, the type of scope used, whether a stent is placed, and what prevention strategy fits you — are decisions to work through with your urologist based on your imaging, your stone history, and your overall health.