A ureteroscopy is a minimally invasive outpatient procedure that urologists perform to diagnose conditions affecting the urinary tract. It is most often used to treat urinary stones. It may also help address other types of blockages within the urinary system. The procedure may be done using two different approaches. This article explains what is ureteroscopy and how the procedure is performed.
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What is Ureteroscopy?
Ureteroscopy is a medical procedure to examine the kidneys and ureters using a specialised instrument called a ureteroscope. It is commonly performed to identify and manage blockages, stones, or other abnormalities within the urinary tract.
A ureteroscope is a slim, tube-like device fitted with a light and a small camera or lens that helps the provider view the urinary system clearly. Tiny instruments can also be passed through the scope to treat certain conditions during the procedure. A rigid ureteroscope is generally used for issues located in the lower ureter near the bladder, while a flexible ureteroscope is preferred for conditions affecting the upper ureter and kidney.
What is Ureteroscopy used to treat?
Ureteroscopy is used to identify and manage conditions affecting the urinary tract, including:
- Stones in the ureter
- Kidney stones
- Other forms of blockage, such as ureteral narrowing (strictures), tumours, or polyps
The procedure may also be recommended to investigate and treat possible causes of blood in the urine.
Ureteroscopy can be an effective treatment option for people who:
- Have multiple kidney stones
- Have a stone causing obstruction within the ureter
- Have a large stone that is unlikely to pass naturally
- Are pregnant
- Have obesity
- Have a bleeding or clotting disorder
- Take blood-thinning medications
In many cases, ureteroscopy is used to treat stones measuring between 5 and 20 mm.
How common is ureteroscopy?
Ureteroscopy is a widely performed procedure for treating stones within the urinary tract. Kidney stones are relatively common, affecting around 1 in 10 people in the United States at some point in their lifetime. Although kidney stones have traditionally been more frequent in males, the difference in occurrence between males and females has been decreasing over time.
What is the procedure for ureteroscopy?
During a ureteroscopy, a thin instrument called a ureteroscope is carefully guided through the urethra, into the bladder, and up the ureter toward the kidney. This allows the healthcare provider to locate, break apart, or remove kidney stones that are unable to pass naturally through the urinary tract.
Is ureteroscopy a major or minor procedure?
Ureteroscopy is a minimally invasive procedure, not a major surgery. It is commonly performed as an outpatient treatment, meaning most people can return home the same day.
How to prepare for a ureteroscopy
Your healthcare provider will give you specific instructions before the procedure. Preparation steps may include:
- Avoiding solid food after midnight before the procedure, although clear liquids may sometimes be allowed up to two hours before arrival
- Temporarily stopping certain medications or taking them with only a small sip of water, but only if advised by your provider
- Completing a urine test beforehand to check for a urinary tract infection (UTI); antibiotics may be prescribed if an infection is found
- Undergoing imaging tests, such as a CT scan or MRI, to provide a detailed view of the urinary tract
Who is part of the care team?
A ureteroscopy procedure is typically carried out by a specialised healthcare team, which may include:
- A urologist
- Certified registered nurse anesthetist (CRNA)
- Nursing staff
- Scrub technicians
What happens during the procedure?
Before the procedure begins, the anesthesiologist or certified registered nurse anesthetist (CRNA) will administer general anesthesia through an IV line, usually placed in your arm. This ensures that you remain asleep, comfortable, and free from pain throughout the procedure. Once the anesthesia takes effect, the urologist gently inserts the ureteroscope through the urethra and advances it into the bladder and urinary tract.
There are generally two main approaches used during ureteroscopy to treat stones:
- For smaller stones: The urologist may pass a tiny instrument through the ureteroscope. This instrument may include a small basket or a laser. The basket can be used to remove the stone directly, while the laser can break the stone into smaller fragments or fine dust.
- For larger stones: A flexible fiber is guided through the ureteroscope to reach the stone. A laser is then used to fragment the stone into tiny pieces. These fragments may be removed using suction or flushing techniques, while some particles naturally pass out of the body during urination. In many cases, patients do not notice the small fragments as they leave the urinary tract.
The treatment method chosen depends on several factors, including the stone’s size, location, and mineral composition
Is a stent necessary after ureteroscopy?
After the procedure, they usually place a ureteric stent to help the urinary system heal properly. One end of the stent is placed in the kidney, and the other in the bladder. The stent keeps the ureter open, allowing urine and any remaining stone fragments to pass more easily during recovery. Since the stent stays entirely inside the body, there is no need for an external urine collection bag. It is typically removed within a few days to a couple of weeks after the ureteroscopy.
In some cases, the stent may have a small “pull-out” string that passes through the urethra and is taped to the leg. This makes it possible for the patient to remove the stent at home if advised by the doctor. Alternatively, a nurse or healthcare professional can remove the stent during a follow-up office visit.
What happens after the procedure?
Following the procedure, healthcare providers will observe you in a recovery area for about 1 to 2 hours to ensure you are recovering well from anesthesia. They will also provide instructions on managing any mild pain or discomfort after the procedure. Since ureteroscopy is typically performed as an outpatient procedure, most patients can return home on the same day.
In some cases, the removed stone may be sent to a laboratory for further analysis. Examining the stone helps identify its type and possible cause, which can also assist in planning strategies to reduce the risk of future stone formation.
How long does the procedure take?
A ureteroscopy generally takes around one to two hours to complete. However, including preparation time and post-procedure recovery, patients should expect to spend approximately four hours or more at the hospital or surgical center.
What are the benefits and risks of ureteroscopy?
Benefits of ureteroscopy
Ureteroscopy offers several advantages for the treatment of urinary stones and related conditions, including:
- The procedure is minimally invasive, and it avoids the need for surgical incisions.
- It is usually performed as an outpatient procedure, allowing patients to return home the same day
- It can effectively treat stones that may not respond well to other treatments, such as extracorporeal shock wave lithotripsy (ESWL)
Possible risks and side effects
Although ureteroscopy is generally considered safe, like any medical procedure, it may involve certain risks or complications, such as:
- Side effects related to anesthesia
- Infection
- Injury to the ureter or other parts of the urinary tract
- Temporary difficulty emptying the bladder due to urinary retention, which may require a short-term urinary catheter
- Movement or displacement of the ureteral stent, which can affect urinary control
- Scar tissue formation that may later lead to narrowing or blockage of the ureter
It is also common to notice some blood in the urine after the procedure, especially when a stent is in place. The urine may appear darker or bloodier during physical activity, but light activities such as walking are generally encouraged. Drinking plenty of water can help flush the urinary system and keep the urine clearer during recovery.
For patients with multiple or very large stones, an additional procedure may sometimes be needed to completely remove all stone fragments. Healthcare providers usually discuss this possibility before treatment.
How painful is ureteroscopy?
Most patients describe discomfort after ureteroscopy as mild to moderate. Pain and irritation can often be managed with:
- Over-the-counter or prescribed pain medications
- Medications that help relax the urinary tract and reduce bladder discomfort
- Ice packs
- Heating pads or warm compresses
- Drinking adequate fluids, especially water, to support recovery and urine flow
What Is the Recovery Process and Outlook After Ureteroscopy?
Recovery after the procedure
Most people can resume their usual daily activities within a few days after the ureteral stent is removed. However, while the stent is in place and sometimes briefly afterward, it is common to experience:
- Mild cramping
- Pain or burning during urination
- Pink, red, or lightly blood-tinged urine
- A frequent or urgent need to urinate
- Discomfort or pressure in the bladder area
In some cases, it can take up to eight weeks or longer for all stone fragments to pass completely through the urinary tract. Staying well-hydrated by drinking plenty of water may help the process.
Patients with a ureteral stent may notice increased discomfort or fatigue during recovery. Occasionally, a small stone fragment can become trapped near the stent. This may pass during or shortly after stent removal and can temporarily cause pain or irritation. Staying hydrated and using prescribed medicines can help control these symptoms.
When to contact your urologist
You should contact your healthcare provider if you:
- Have concerns or questions after the procedure
- Experience significant or worsening pain
- Develop symptoms of a urinary tract infection (UTI), such as fever below 101°F (38°C), chills, or difficulty urinating
- Notice that the ureteral stent has moved or fallen out
When to seek emergency medical care
Get some medical help immediately if you notice:
- A fever higher than 101°F (38°C)
- Bright red urine or large blood clots in the urine
- Severe nausea or vomiting
- Inability to urinate for six hours or longer
- Intense spasms or severe pain after stent removal that does not improve with prescribed medications
Conclusion
Ureteroscopy is a safe, minimally invasive procedure commonly used to diagnose and treat kidney stones and other urinary tract obstructions. With advanced techniques, faster recovery, and high success rates, it remains an effective treatment option for many patients experiencing urinary stone-related conditions.
FAQs
1. How painful is a ureteroscopy?
Most patients experience mild to moderate discomfort after a ureteroscopy. Common symptoms may include burning during urination, mild cramping, bladder irritation, or temporary discomfort from the ureteral stent. These symptoms are usually manageable with medications, hydration, and rest.
2. What is the recovery time after a ureteroscopy?
Recovery time varies from person to person, but many patients can return to normal activities within a few days after the stent is removed. Some mild urinary symptoms or discomfort may continue for a short period, and small stone fragments can take several weeks to fully pass.
3. What size kidney stone requires ureteroscopy?
Ureteroscopy is commonly used to treat kidney stones that are approximately 5 mm to 20 mm in size. It may also be recommended for stones causing blockage, severe pain, infection, or stones that are unlikely to pass naturally.
4. What are the side effects of a ureteroscopy?
Possible side effects after ureteroscopy may include blood in the urine, burning during urination, bladder discomfort, frequent urination, mild pain, fatigue, or temporary stent-related irritation. In rare cases, complications such as infection, urinary retention, or injury to the ureter may occur.