Ureteroscopy is a minimally invasive procedure where a thin, lighted scope is passed through the urinary tract to diagnose or treat problems in the ureters and kidneys. It is most commonly used to break up and remove kidney stones, but it also serves as a tool for biopsying tumors, treating blockages, and evaluating unexplained bleeding in the upper urinary tract. The procedure typically takes about an hour and is performed under general anesthesia.
How the Procedure Works
During ureteroscopy, a urologist inserts a long, narrow scope through the urethra, up through the bladder, and into the ureter (the tube connecting the kidney to the bladder). The scope has a tiny camera and a light at its tip, giving the surgeon a direct view of the urinary tract’s interior. No external incisions are made.
If a kidney stone is the target, the surgeon threads a laser fiber through the scope to break the stone apart. The most widely used technology for this is the holmium laser, which works by generating intense heat that vaporizes the stone on contact. The laser creates a small vapor bubble in the surrounding fluid, and the energy passes through that bubble to reach the stone’s surface. Depending on the settings, the surgeon can either fragment the stone into pieces large enough to grab with a tiny basket or “dust” it into particles small enough to pass on their own through urine. Newer pulse technology, sometimes called Moses technology, refines this process by splitting the laser energy into two phases: one to clear the fluid and one to reach the stone more efficiently.
For diagnostic purposes, the scope allows the urologist to visually inspect the lining of the ureter and kidney, take tissue samples for biopsy, or treat abnormal growths with laser ablation.
Why It’s Performed
The most common reason for ureteroscopy is kidney or ureteral stones that haven’t passed on their own after four to six weeks, or that continue causing pain, blockage, or infection. It is also used for stones that are too large or too stubbornly positioned for other treatments like shock wave lithotripsy.
Beyond stones, ureteroscopy is used to investigate and treat a range of upper urinary tract problems: ureteral strictures (narrowed segments), tumors or cancers of the ureter or kidney lining, unexplained blood in the urine, and even foreign bodies like fragments of previously placed stents. For suspected urothelial cancer, ureteroscopy allows the surgeon to see the tumor directly, take a biopsy, and in some cases perform laser treatment during the same session.
Preparing for Ureteroscopy
The procedure is done under general anesthesia, so you’ll be asleep throughout. Standard preparation includes fasting after midnight the night before, temporarily stopping blood thinners or aspirin if your surgeon advises it, and arranging for someone to drive you home afterward. Let your surgeon know about all medications you’re taking, including over-the-counter ones, and whether you could be pregnant.
Success Rates by Stone Location
How well ureteroscopy clears stones depends heavily on where the stone is and how big it is. Real-world data shows an overall stone-free rate of about 73% for ureteral stones and roughly 50% for kidney stones. Stones in the lower pole of the kidney and larger or multiple stones are harder to clear completely, which accounts for the gap. Surgeon experience also matters: adjusted stone-free rates ranged from about 52% to 90% for ureteral stones and 26% to 72% for kidney stones across different surgeons in one large collaborative study.
These numbers reflect complete clearance after a single procedure. In cases where fragments remain, a follow-up procedure or monitoring may be recommended.
The Ureteral Stent
After most ureteroscopies, the surgeon places a temporary ureteral stent, a thin flexible tube that holds the ureter open while swelling subsides and healing takes place. Current guidelines recommend keeping the stent in for 3 to 7 days after an uncomplicated procedure, with a minimum of 5 days for patients who didn’t have a stent placed before surgery. Removing it too early (4 days or fewer) is linked to a higher chance of an emergency room visit around the time of removal.
Some stents come with an attached string that hangs outside the body, allowing removal at home or in a quick clinic visit. Stents with strings tend to stay in for a shorter period, around 5 days on average, compared to about 9 days for stents that require an office procedure for removal.
Stent-Related Discomfort
The stent is often the most uncomfortable part of the entire experience. Over 80% of patients report some degree of stent-related symptoms. The most common complaints include a frequent, urgent need to urinate (affecting roughly 60% of patients), a sensation of incomplete bladder emptying (76%), pain during urination (40%), and flank or lower abdominal pain (19 to 32%). Blood in the urine occurs in about 25% of patients and can result from both the procedure itself and the stent irritating the urinary tract lining. These symptoms vary widely from person to person and generally resolve once the stent is removed.
Recovery After the Procedure
Most people can return to normal daily activities within two to three days. You should expect some blood in your urine for the first day or two, along with mild burning during urination. If a stent is in place, the urinary frequency and discomfort will persist until it comes out. Drinking plenty of water helps flush the system and can ease some of the irritation.
Risks and Complications
Ureteroscopy is considered safe, with an overall complication rate of about 10.6% in population-level studies. Most complications are minor. Among those who needed medical attention within two weeks of the procedure, the most common reasons were infection (about 32% of complications), pain (22%), and bleeding (10%). Urinary tract infections occur in roughly 2 to 4% of cases, and serious infection progressing to sepsis happens at a similar rate of 2 to 4%.
Rare but more serious risks include ureteral perforation or injury during the procedure, with intraoperative complication rates reported between 3.8% and 7.7% depending on stone location. Long-term, ureteral strictures (scarring that narrows the ureter) can develop but are uncommon. About 7% of patients in one study required hospital readmission within two weeks of surgery.