Ureteroscopy

A ureteroscopy is a procedure in which a healthcare provider uses a tool to look inside your kidneys and ureters. Providers use ureteroscopy (yoo-ree-tuh-ROS-keh-pee) to evaluate and treat blockages and abnormalities in your urinary system.

The tool providers use is a ureteroscope. It’s a long, thin tube that has an eyepiece on one end. The other end has a tiny lens and a light. They can feed instruments through the scope to help them treat certain conditions. Providers may use a rigid ureteroscope if something affects the lower part of your ureter, near your bladder. They’ll use a flexible ureteroscope to treat conditions in the upper ureter and kidney.

Other names for ureteroscopy are:

• Flexible ureteroscopy
• URS

What does it treat?

Healthcare providers most commonly perform ureteroscopy to diagnose and treat:

• Ureteral stones
• Kidney stones
• Other blockages, including narrowing (strictures) and irregular growths like tumors or polyps

They may also suggest the procedure to evaluate and treat causes of blood in your pee.

Ureteroscopy might be a good option to treat a stone if you:

• Have multiple stones in your kidneys
• Have a stone that causes a blockage in any part of your ureter
• Have a large stone that causes a blockage and won’t pass on its own
• Are pregnant
• Have obesity
• Have a blood-clotting disorder
• Are on blood thinners

Providers can use ureteroscopy for stones between 5 millimeters and 20 millimeters.

How common is it?

Ureteroscopy is a common procedure to treat stones in your urinary system. About 1 out of every 10 people in the U.S. develop a kidney stone at least once during their lives. Kidney stones are more common in males than females. But that gap is narrowing.

Is ureteroscopy a major or minor surgery?

It’s a minor procedure. In most cases, it’s an outpatient procedure. That means you can go home the same day as the ureteroscopy.

How should I prepare for a ureteroscopy?

Your healthcare provider will explain the procedure to you and give you instructions on how to prepare. These may include:

• No solid foods after midnight before the procedure (fasting), though your provider may allow you to have a small amount of clear liquids up to two hours before your arrival time.
• Stop taking medications before the ureteroscopy or take them with just a sip of water. Don’t stop taking medications unless your provider tells you to.
• Arrange for someone to drive you home afterward.
• Get a pee test in the weeks leading up to the procedure to check for a urinary tract infection (UTI). If you have an infection, you may have to take an antibiotic.
• Get imaging tests (CT scan or MRI) to get a detailed look at your urinary system.

Who makes up my care team?

A ureteroscopy care team generally consists of:

• A urologist
• An anesthesiologist or nurse anesthetist (CRNA)
• Nurses
• Scrub technicians

What happens during the procedure?

Your anesthesiologist or CRNA will give you general anesthesia through an IV, usually in your arm. That means you’ll be asleep, won’t move and won’t feel any pain during the procedure. Your urologist will then insert the ureteroscope into your urethra and guide it into your bladder.

In general, there are two ways to perform a ureteroscopy for stones.

If the stone is small, your urologist will feed a smaller instrument through the ureteroscope. The smaller instrument may have a basket or laser at the end. Depending on what the provider feels is best, they’ll use the basket to collect the stone or the laser to break it up into smaller pieces or dust.

For larger stones, your urologist will extend a flexible fiber through the ureteroscope up to the stone. A laser shines through the fiber and breaks the stone into tiny pieces or dust. Your urologist will suction or flush out the pieces. Pieces also naturally move through your urinary system when you pee. You may not see or feel anything as they clear.

Your urologist will determine the best approach according to the location, size and composition (the mineral makeup) of your stone.

Do you need a stent after ureteroscopy?

Yes, a provider will place a ureteral stent. One end will be in your kidney, and the other end will be in your bladder. The stent holds your ureter open, which helps your body drain pee and clear any stone pieces while you recover. The stent is completely in your body. You won’t need a bag to collect your pee. They’ll remove the stent a few days to a couple weeks after the ureteroscopy.

In some cases, the stent may have a “pull-out” string. The pull-out string passes through your urethra, and your provider secures it to your leg. If you have a pull-out string, you or a loved one can remove the stent at home. But a nurse can also remove it for you in an office setting if you’d prefer.

What happens after the procedure?

After the procedure, healthcare providers will monitor you in a recovery room for an hour or two. They’ll also explain how you can safely manage any discomfort or pain. Ureteroscopy is an outpatient procedure. That means you should be able to go home the same day.

They may also send your stone to a lab for analysis. This helps determine the type of stone it is. It also gives clues as to the cause. It may even help guide prevention strategies.

How long does it take?

A ureteroscopy usually takes an hour or two. But you should plan to be at the hospital or surgery center for at least four hours that day.

What are the potential benefits and risks?

Advantages of ureteroscopy include:

• It’s minimally invasive. Your urologist doesn’t need to make an incision (cut) to perform it.
• It’s an outpatient procedure. You should expect to go home the same day.
• It can break up stones that other stone procedures can’t, like extracorporeal shock wave lithotripsy (ESWL).

Though ureteroscopy is generally safe, every medical procedure has risks. Ureteroscopy risks or side effects may include:

• Anesthesia risks
• Infection
• Injury to your ureter or other parts of your urinary system
• Inability to completely empty your bladder because of urinary retention, which may require a temporary urinary catheter
• Your stent dislodging or falling out, which affects your ability to control your pee
• Scarring, which may eventually cause narrowing or a blockage

Although it may be a shock, it’s also normal to see some blood in your pee after the procedure, especially when you have a stent. Your pee may look worse when you’re more active. But you should not stop moving. Moderate activities, like walking, are still okay. It’s important to drink plenty of water to flush your kidneys out and keep your pee as clear as possible.

If you have lots of stones or very large stones, there’s also a chance that you may need a second procedure to remove all of them. Your provider will usually talk to you about this before the first procedure.

How painful is it?

Most people describe ureteroscopy pain as mild or moderate. Many people treat their pain with:

• Over-the-counter and prescription pain medications
• Prescription medications to relax your urinary system and reduce bladder discomfort
• Ice packs
• Heating pads
• Warm compresses
• Drinking plenty of fluids, especially water

What is the recovery time?

You should be able to return to your normal activities a few days after the stent comes out. Until then, and sometimes for a few days after, you may experience:

• Cramping
• Pain or discomfort when you pee
• Pink or red-tinged pee
• Frequent or urgent need to pee
• Bladder pain

It may take eight weeks or longer for all the stone pieces to clear after the procedure. Drinking lots of water can help.

If you have a ureteral stent, you may have more discomfort and feel very tired. Sometimes, a small piece of stone may get stuck alongside the stent. It may pass as a provider removes the stent or shortly after. If this happens, it may cause temporary pain or discomfort. Taking medications as directed and drinking plenty of fluids can help.

When should I call my healthcare provider?

Contact your healthcare provider if:

• You have any questions at any time after the procedure
• You have a lot of pain
• You have signs of a UTI, including a fever less than 101 degrees Fahrenheit (38 degrees Celsius), chills or problems peeing
• Your stent falls out

Go to the nearest emergency room (ER) if you experience

• A fever greater than 101 F (38 C)
• Excessively bright red pee or blood clots in your pee, which may look thick and don’t mix with your pee
• Uncontrollable nausea or vomiting
• Inability to pee for six hours
• Extreme spasms in your affected areas after your provider removes your stent, which don’t go away or improve after taking prescribed medications