Ureteroscopy with laser lithotripsy
A thin telescope is passed through the urethra and bladder up into the ureter or kidney, and a laser breaks the stone into dust or small pieces that are removed or passed in your urine. There are no cuts on the skin.
Also called URS, ureteroscopy, laser lithotripsy, holmium laser lithotripsy, thulium fiber laser, flexible ureteroscopy, retrograde intrarenal surgery, RIRS
- Where
- Hospital or outpatient surgery center operating room
- Anesthesia
- General anesthesia (fully asleep), sometimes spinal anesthesia
- Time in the room
- 30 to 90 minutes; longer for large kidney stones
- Hospital stay
- Same day in most cases
- Going home with
- Often a ureteral stent for 3 to 14 days, sometimes with a string so it can be pulled out at home
- Back to normal
- 2 to 7 days, or once the stent is out
- Back to work
- 2 to 3 days for desk work; heavy physical work usually after the stent is removed
Overview
Ureteroscopy is the most common operation for kidney and ureter stones in the United States. Your surgeon passes a ureteroscope, a telescope thinner than a pencil, in through the urethra (the tube that carries urine out of your body), through the bladder, and up the ureter (the tube that carries urine from the kidney to the bladder). Nothing is cut on the skin. A laser fiber about as thin as fishing line goes through the scope to break the stone.
There are two kinds of ureteroscope. A semi-rigid scope, which is straight, works well for stones in the lower and middle ureter. A flexible scope bends at its tip to reach stones in the upper ureter and inside the kidney. The laser is usually a holmium laser or a newer thulium fiber laser. Both can break stones of any hardness.
Your surgeon can use the laser in two ways. Dusting turns the stone into fine sand that washes out in your urine over the following days and weeks. Fragmenting splits the stone into pieces that are pulled out one by one with a tiny wire basket. Many surgeons combine the two. Studies comparing them show similar results, so the choice depends on your stone and your surgeon's practice.
At the end, many people get a ureteral stent, a soft plastic tube that sits inside you from the kidney to the bladder, for a few days to two weeks. It keeps urine draining while the ureter heals from swelling. For many people the stent is the most uncomfortable part of the whole experience. After a short, uncomplicated procedure, your surgeon may decide you do not need one.
The parts of your body involved
Your kidneys sit high in the back of your belly, tucked under the lower ribs on each side. Inside each kidney, urine collects in small cup-shaped chambers called calyces and flows into a funnel called the renal pelvis. From there the ureter, a muscular tube about 10 to 12 inches (25 to 30 centimeters) long and only a few millimeters wide inside, carries urine down to the bladder. Stones form in the kidney. When one breaks loose, it tends to stick at the ureter's narrow spots: where it leaves the kidney, where it crosses the blood vessels to the leg, and where it enters the bladder. A stuck stone backs up urine, which stretches the kidney (hydronephrosis) and causes the severe, wave-like pain called renal colic.
- Kidney
Filters blood and makes urine. It sits under the lower ribs, toward your back.
- Calyces and renal pelvis
The cup-shaped chambers and the funnel inside the kidney where urine collects. Kidney stones usually sit here. The lowest cups (the lower pole) drain uphill, so pieces there clear more slowly.
- Ureter
The narrow tube from kidney to bladder. It squeezes in waves to move urine down. A stone stuck here causes most stone pain.
- Ureter opening in the bladder
The ureter enters the bladder through a short tunnel in the bladder wall. This is the narrowest point and the most common place for a stone to stick.
- Bladder and urethra
The path the scope takes on the way up. They are not cut, but they can burn and feel sore for a day or two.
Why it’s done
Most stones smaller than 5 millimeters pass on their own within a few weeks. Bigger stones are less likely to pass, and some stones cause problems that should not wait. Ureteroscopy is offered when a stone is unlikely to pass, when waiting is not safe, or when a kidney stone is causing trouble.
- The stone is too big to pass
Stones larger than about 10 millimeters (0.4 inch) rarely pass on their own, and many between 5 and 10 millimeters get stuck.
- Pain that will not settle
Repeated emergency visits, pain that medicines do not control, or vomiting that stops you from drinking are all reasons to remove the stone.
- The stone has not moved
If a stone is still stuck after about 4 to 6 weeks, the chance it will pass drops and the risk to the kidney rises.
- Blockage with infection
A blocked, infected kidney is an emergency. The first step is drainage with a stent or a nephrostomy tube plus antibiotics. Ureteroscopy is done later, once the infection has cleared.
- Protecting kidney function
A single kidney, a kidney that already works poorly, or blockage on both sides calls for earlier treatment.
- Kidney stones that cause trouble
Stones sitting in the kidney that bleed, cause infections or pain, or keep growing on scans. Pilots and people who travel to remote places may choose treatment for safety.
Other options
- Waiting, with medicine to help the stone pass
For a stone up to about 10 millimeters in the ureter, with pain under control and no infection, you can try to pass it for up to 4 to 6 weeks. Tamsulosin, a pill that relaxes the ureter muscle, helps some stones pass, especially larger stones in the lower ureter. You strain your urine to catch the stone.
- Shock wave lithotripsy
Shock waves from a machine outside the body break the stone without a scope. It works best for kidney or upper ureter stones under 1 to 2 centimeters that are not too hard. It is less likely than ureteroscopy to clear the stone in one session, and it rarely needs a stent.
- Percutaneous nephrolithotomy (PCNL)
A keyhole operation through the back, preferred for kidney stones larger than about 2 centimeters and for larger stones in the lowest part of the kidney.
- A stent or nephrostomy tube first
When the kidney is infected or you are too unwell for stone surgery, a stent or a tube through the back drains the kidney first. The stone is treated later.
- Medicine to dissolve uric acid stones
Uric acid stones can sometimes dissolve when the urine is made less acidic with potassium citrate or a similar medicine. This takes weeks to months and does not work for the more common calcium stones.
- Watching a kidney stone that causes no trouble
Small stones sitting quietly in the kidney, with no pain, blockage or infection, can often be watched with periodic scans while you work on prevention.
Getting ready
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Weeks before
The week before
The day before
The morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep and getting positioned
You lie on your back and the anesthesiologist puts you fully to sleep. Your legs are then raised and rested in padded stirrups. This position, called lithotomy, gives your surgeon a straight path to the urethra.
More detail
The team pads pressure points and moves both legs together to protect your hips and knees. Being fully asleep keeps you still, which matters when the laser is working a few millimeters from the lining of the ureter.
After the operation
Right afterward
- Waking up
You wake in the recovery room a few minutes after the procedure. Burning in the urethra, a strong urge to urinate and an ache in your side are expected. Most people go home within 1 to 2 hours.
- Urinating before you leave
Many centers ask you to urinate before going home. Pink or red urine is normal.
- If your stent has a string
The string comes out of the urethra and is taped to your thigh or penis. The nurse shows you how to keep it secure and tells you the date to remove it.
- Your medicines
You usually go home with a pain plan and often medicines for stent discomfort, such as tamsulosin and a bladder relaxer.
- Getting home
An adult must drive you. Do not drive, sign important papers or drink alcohol for 24 hours after anesthesia.
At home
- Pain and stent discomfort
Side ache, bladder spasms and frequent urges are common while a stent is in. Anti-inflammatory pain pills such as ibuprofen work well for stent pain if your kidney function allows them. Tamsulosin and a bladder relaxer such as oxybutynin or solifenacin help many people. Phenazopyridine eases burning for a day or two and turns urine bright orange. If you take an opioid, add a stool softener to avoid constipation.
- Blood in the urine
Pink to red urine comes and goes while a stent is in, especially after activity. Drinking more usually clears it. Small clots can happen. Thick clots, urine like ketchup, or trouble passing urine need a call.
- Drink plenty
Drink enough to keep your urine pale yellow, for most people about 2.5 to 3 liters (10 to 12 cups) a day, unless a doctor has limited your fluids.
- Activity
Walk from the first day. Normal daily activity is fine. Running, hard exercise and heavy lifting tend to make stent pain and bleeding worse, so most people wait until the stent is out.
- Driving
No driving for at least 24 hours after anesthesia or while taking opioid pain medicine. After that, drive when you can turn and brake comfortably.
- Showering
You can shower the next day. If you have a string, keep it taped and pat it dry afterward.
- Work
Many people return to desk work in 2 to 3 days. Jobs with heavy labor or long drives are often easier after the stent is out.
- Sex
Sex is safe when you feel comfortable. Tape a string out of the way. Some people find sex uncomfortable until the stent is removed.
- Stent removal date
Know your removal date before you leave. A string stent is usually pulled out at home or in the office 3 to 7 days after surgery. A stent without a string is removed with a quick office cystoscopy. A stent left in too long can crust over, so never let the date pass without a plan.
- Preventing the next stone
The stone is usually sent for analysis, and people with repeat stones or higher risk are often asked to do a 24-hour urine test. Steps that help most people: drink enough to make about 2.5 liters of urine a day, keep sodium to about 2,300 milligrams a day or less, eat normal amounts of calcium from food (about 1,000 to 1,200 milligrams a day), go easy on meat, poultry and seafood, eat plenty of fruits and vegetables, and avoid sugar-sweetened drinks. With calcium oxalate stones you may be asked to limit high-oxalate foods such as spinach, nuts and rhubarb, and to skip high-dose vitamin C supplements.
Recovery timeline
- Day 0Home the same day
Burning, urges and pink urine are expected. Rest, drink, and take your medicines on schedule.
- Days 1 to 3Stent symptoms peak
Side ache when you urinate, frequent urges and blood that comes and goes are usual. Most people are up and about at home.
- Days 3 to 14The stent comes out
A string stent is often removed at 3 to 7 days. A stent without a string is removed in the office, often within 1 to 2 weeks. Longer if the ureter was injured or tight.
- Removal dayA few hours of cramping for some
Some people get a short spell of strong side pain a few hours after removal as the ureter adjusts. An anti-inflammatory pill helps if you are allowed one.
- Weeks 1 to 4Dust passes
You may see sand or grit in your urine. Most activity is back to normal once the stent is out.
- Weeks 4 to 8Follow-up scan
An ultrasound, X-ray or low-dose CT checks that the kidney drains well and looks for leftover pieces. Many surgeons order this even if you feel fine, because a narrowing can block a kidney without pain.
- Months 1 to 3A prevention plan
The stone analysis and, for many people, a 24-hour urine test guide diet changes or medicines that lower the chance of another stone.
- Long termStaying stone-free
Stones often come back. Without prevention, up to half of people form another stone within 5 to 10 years. Steady fluids and diet changes lower that risk.
What it feels like
Most people say the operation itself was easy because they slept through it. The stent is what they remember. Knowing what is normal makes those days easier to get through.
The night before
You may still have stone pain, or a dull fear of it coming back. Many people worry about the stent they have heard about from friends, or about missing work.
What helpsWrite down your questions for the morning. Ask whether you will have a stent and for how long. Pack your pain medicines and a water bottle for the ride home.
Waking up
Burning in the urethra and a strong urge to urinate, even with an empty bladder. Your side may ache like a bruise. Some people feel cold or shaky as the anesthesia wears off.
What helpsTell the nurse about pain early. Warm blankets help. The urge eases as the bladder settles.
The first time you urinate
Burning at the tip of the urethra, pink urine, and often a sharp ache in your side right as you urinate. That side ache is urine pushing back up the stent, and it fades within a minute or so.
What helpsDrink steadily so the urine stays dilute. Take your time and breathe out slowly while you go.
Living with the stent
Frequent trips to the bathroom, a feeling of not quite emptying, and a pulling ache in the side or bladder, often worse after walking or at night. Many people are surprised by how tiring it is. Frustration is common.
What helpsTake the stent medicines on a regular schedule rather than waiting for pain. A heating pad on your side or lower belly helps. Plan easy days and remind yourself it is temporary.
The string
If your stent has a string, you may feel self-conscious about it and worry about catching it on clothing or pulling it out by accident.
What helpsTape it with a little slack and wear snug underwear. If it comes out early, call your team. It is only urgent if pain or fever follows.
Stent removal
Pulling a string stent feels like a long, slippery slide, over in a few seconds. Office removal with a scope takes about a minute and feels like pressure and a brief sting.
What helpsBreathe out slowly as it comes out. Ask whether to take an anti-inflammatory pill an hour before. Keep the afternoon free in case you cramp.
Passing the dust
For a week or two you may see grit or sand in the toilet, sometimes with a twinge. Many people find it oddly satisfying to see.
What helpsStrain your urine if your surgeon wants pieces. Keep drinking to wash out the rest.
Afterward
Relief, and often a new worry: will this happen again?
What helpsAsk for your stone analysis and a prevention plan. The habits that prevent stones are simple, and they work best when started now.
How well it works
Success means the stone is gone or only tiny fragments remain, the kidney drains normally, and the pain is over. For stones in the ureter, about 9 in 10 people are stone-free after one ureteroscopy. Larger kidney stones are more likely to need a second procedure.
- Stone-free status
A follow-up ultrasound, X-ray or low-dose CT, usually 4 to 8 weeks later, shows whether any pieces remain. Very small fragments often pass or stay quiet, and are watched.
- Kidney drainage
The same scan confirms the kidney is no longer swollen, which rules out a silent blockage or narrowing.
- Stone analysis
The lab reports what the stone is made of, such as calcium oxalate, calcium phosphate, uric acid, struvite or cystine. Each type has its own prevention plan.
- 24-hour urine test
For people with more than one stone, or at higher risk, collecting all urine for a full day shows the chemistry behind the stones and guides diet changes or medicines.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Urges, frequent urination, burning, and side pain when you urinate while the stent is in. It ends when the stent is removed.
Pink or red urine for a few days, and on and off while a stent is in.
Usually lasts 1 to 3 days.
Small pieces may remain, especially after large kidney stones. Many pass on their own. Some need a second procedure.
Less common
Fever after ureteroscopy usually responds to antibiotics. Testing and treating the urine before surgery lowers the risk.
If the scope cannot pass safely, the surgeon places a stent and returns in 1 to 2 weeks, once the ureter has widened.
A few hours of strong cramping side pain as the ureter adjusts. It usually settles with anti-inflammatory medicine.
More likely with a string stent. Call your team if it comes out before the planned date.
Usually heals on its own over a stent left in a little longer.
More likely when a kidney stone is larger than about 1.5 to 2 centimeters or sits in the lowest part of the kidney.
Rare
Scar tissue can narrow the ureter weeks to months later and block the kidney, sometimes without pain. This is one reason for the follow-up scan. It may need a dilation, a stent or surgery.
Infection that spreads to the blood and needs hospital care with IV antibiotics, sometimes in intensive care.
A major tear that needs open or robotic repair is very rare.
A stent left in for many months can become crusted with stone and hard to remove, sometimes needing more surgery. Keeping your removal date prevents this.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Pain in your side or belly that your prescribed medicines do not control
- You cannot urinate, or your bladder feels full and painful and will not empty
- Thick clots, urine that looks like ketchup, or bleeding that does not lighten after you drink more
- Vomiting that keeps you from holding down fluids or medicines
- The stent or its string comes out before the planned date, or the removal date passes without a plan
- Chest pain, shortness of breath, or a swollen, painful leg (call 911 for chest pain or trouble breathing)
Questions to ask your surgeon
- Where exactly is my stone, how big is it, and how hard does it look on the CT scan?
- Why do you recommend ureteroscopy for me rather than shock waves, PCNL, or more time to pass it?
- Will you use a flexible scope, and will you place an access sheath?
- Do you plan to dust the stone, remove pieces with a basket, or both?
- Will I have a stent? For how long, and will it have a string?
- What medicines will you give me for stent discomfort?
- How likely is it that I will need a second procedure?
- Do I need to stop my blood thinner, and who tells me when to restart it?
- Will my stone be analyzed, and should I do a 24-hour urine test?
- When is my follow-up scan, and what kind will it be?
- When can I go back to work, exercise or travel?
Words you may hear
- Ureteroscope
- A thin telescope, straight (semi-rigid) or bendable (flexible), passed up the ureter to see and treat stones.
- Ureter
- The narrow muscular tube that carries urine from each kidney to the bladder.
- Calyx
- One of the small cup-shaped chambers inside the kidney where urine first collects. Plural: calyces.
- Renal pelvis
- The funnel in the center of the kidney where the calyces drain before urine enters the ureter.
- Laser lithotripsy
- Breaking a stone with laser energy. Lithotripsy means stone breaking.
- Holmium and thulium lasers
- The two kinds of laser used to break urinary stones. Both work only at the tip of a thin fiber.
- Ureteral stent
- A soft plastic tube with a curl at each end that sits inside the ureter from kidney to bladder to keep urine draining.
- Access sheath
- A smooth hollow tube placed in the ureter so a flexible scope can pass in and out easily.
- Basket
- A tiny wire cage that opens around a stone fragment so it can be pulled out.
- Dusting
- Using quick, gentle laser pulses to turn a stone into fine sand that passes in the urine.
- Fragmenting
- Using the laser to split a stone into pieces that are then removed with a basket.
- Hydronephrosis
- Swelling of the kidney's drainage system because urine is backed up behind a blockage.
- Fluoroscopy
- Live X-ray pictures used during the procedure to guide wires, scopes and stents.
- 24-hour urine test
- Collecting all your urine for a full day so a lab can measure the chemicals that cause stones.
Common questions
Will I definitely have a stent?
Not always. After a short, uncomplicated procedure for a stone in the ureter, many surgeons leave the stent out. A stent is more likely after kidney stone work, when the ureter was tight or swollen, when an access sheath was used, or when pieces remain. Your surgeon often makes the final decision at the end, based on what they see.
Can I keep my stone?
The pieces are usually sent to the lab, because knowing the stone type guides prevention. Ask if you would like any leftover pieces or a photo. A dusted stone may leave little to see.
Why can't the laser clear a big stone in one go?
The ureter and kidney are small and delicate, and large stones take a long time to break. Surgeons limit operating time and fluid pressure inside the kidney to lower the risk of infection. For very large stones, a planned second session or PCNL can be safer.
Is ureteroscopy safe if I take a blood thinner?
Ureteroscopy is often the preferred stone treatment for people who cannot stop blood thinners, because nothing is cut. Bleeding is still more likely, so the decision is made with you and the doctor who prescribes the medicine.
Why does my side hurt when I urinate with the stent in?
The stent holds open the natural valve where the ureter enters the bladder. When you urinate, pressure pushes a little urine back up to the kidney and stretches it briefly. It is harmless and stops when the stent comes out.
Can I fly or travel with a stent?
Yes. A stent does not set off airport security. Carry your medicines, drink well, and plan the trip around your removal date.
What can I eat to prevent another stone?
The most helpful step is drinking enough to make about 2.5 liters of urine a day. Eat less salt and less meat, keep normal calcium from food (calcium binds oxalate in the gut), eat plenty of fruits and vegetables, and skip sugary sodas. Your stone type and 24-hour urine results may add specific steps, such as limiting high-oxalate foods or taking potassium citrate.
How soon will I know if it worked?
Your surgeon can tell you right after the procedure how much stone was cleared. The follow-up scan a few weeks later confirms it.
Sources this page draws on
- American Urological Association and Endourological Society, Surgical Management of Stones: AUA/Endourological Society Guideline (2016)
- American Urological Association, Medical Management of Kidney Stones: AUA Guideline (2014)
- European Association of Urology, EAU Guidelines on Urolithiasis
- EDGE Research Consortium, Journal of Urology, Dusting versus basketing during ureteroscopy: a prospective multicenter randomized trial (2018)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Kidney Stones
- Urology Care Foundation, Kidney Stones
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.