A ureteroscopy is a procedure where a doctor passes a thin, flexible scope through your urethra and bladder and up into your ureter (the tube connecting your kidney to your bladder) to find and treat problems like kidney stones. It requires no incisions. The scope has a tiny camera on the end, letting the surgeon see inside your urinary tract in real time and, when needed, break apart stones with a laser or take tissue samples.
Why It’s Done
The most common reason for a ureteroscopy is kidney stones that haven’t passed on their own after four to six weeks, or stones that keep causing pain. But it’s not limited to stones. Doctors also use ureteroscopy to investigate unexplained blood in your urine, remove foreign bodies like broken or migrated stents, evaluate suspicious growths or blockages in the ureter or kidney, and biopsy tissue that looks abnormal on imaging.
Types of Scopes Used
There are two main types of ureteroscopes, and your surgeon may use one or both during a single procedure.
A semi-rigid ureteroscope is sturdier, less expensive, and has a wider working channel, which means the surgeon can use more instruments and get a clearer view. It works well for stones in the lower and middle portions of the ureter. Its limitation is that it can’t easily bend to reach the upper ureter or the inside of the kidney.
A flexible ureteroscope is much thinner, roughly 3 mm in diameter, and can navigate curves to reach stones or abnormalities deep inside the kidney. For large kidney stones, surgeons sometimes start with the semi-rigid scope to do the bulk of the fragmentation, then switch to the flexible scope to sweep the entire kidney and make sure no fragments migrated into hard-to-see areas.
What Happens During the Procedure
You’ll receive general anesthesia, so you’ll be asleep for the entire procedure. The surgeon inserts the scope through your urethra, passes it through the bladder, and guides it up into the ureter using real-time X-ray imaging. Once the scope reaches the stone or area of concern, the surgeon can use a laser fiber threaded through the scope to break the stone into tiny fragments. Small basket-like tools pull out the pieces.
After the stone is cleared or the biopsy is taken, the surgeon often places a ureteral stent, a soft, thin tube that sits inside the ureter to keep it open. The stent prevents swelling from blocking urine flow while you heal. Most people keep the stent for a few days to a few weeks before it’s removed in a quick office visit.
How Well It Works
Success rates depend heavily on where the stone is and how big it is. A large real-world study of nearly 6,500 ureteroscopies found that 72.7% of patients with ureteral stones were completely stone-free afterward, compared to 49.6% for kidney stones. Stones that are larger, located in the lower part of the kidney, sitting in the upper ureter, or present in multiple spots are harder to clear in a single session. Surgeon experience matters too: adjusted stone-free rates ranged from about 52% to 90% for ureteral stones depending on the individual surgeon.
When stones aren’t fully cleared the first time, a follow-up procedure or additional treatment like shock wave therapy may be recommended.
Risks and Complications
Ureteroscopy is generally safe. In population-level data, the overall complication rate is around 10.6%. The most common issues are urinary tract infections and post-procedure pain. UTI and sepsis (a more serious infection) each occur in roughly 2 to 4% of cases. Intraoperative complications like minor bleeding or ureteral injury happen in about 4 to 8% of procedures, depending on stone location, though serious injury is rare.
How to Prepare
Your surgical team will give you specific instructions, but the basics are straightforward. Let your surgeon know about every medication you take, including over-the-counter drugs and supplements, since some can increase bleeding risk. Mention if you’re pregnant or think you might be. You won’t be able to drive yourself home after general anesthesia, so arrange a ride in advance.
What Recovery Feels Like
Most people go home the same day. In the first few days, you can expect cramping, a frequent or urgent need to urinate, discomfort when you pee, and bladder pain. Most people describe the pain as mild to moderate. Pink or red-tinged urine is normal and can look worse on days you’re more physically active, especially if you have a stent in place.
Stent-related discomfort is one of the most common complaints during recovery. The stent can cause a persistent urge to urinate, flank pain during urination, and general irritation until it’s removed. These symptoms typically ease significantly once the stent comes out.
Signs That Need Attention
Some symptoms after ureteroscopy are expected, but others signal a problem. Contact your doctor if you develop signs of a UTI like a low-grade fever under 101°F, chills, or difficulty urinating, or if your stent falls out. Head to an emergency room if you spike a fever above 101°F, see bright red blood or thick clots in your urine, can’t urinate for six hours or more, or experience uncontrollable nausea and vomiting.