Ureteroscopy (URS) is a minimally invasive urological procedure used to diagnose and treat conditions affecting the urinary tract, particularly the ureter and kidney. It involves inserting a thin, flexible instrument called a ureteroscope through the urethra and bladder into the ureter or kidney. URS enables direct visualization of the urinary tract, allowing for the diagnosis and treatment of conditions such as kidney stones, ureteral strictures, tumors, or other abnormalities with precision and minimal discomfort for the patient.

Types of Ureteroscopy

  • Flexible Ureteroscopy: Utilizes a thin, flexible ureteroscope to access the ureter and kidney through the urethra, allowing navigation through tortuous anatomy and precise treatment of stones or other conditions.
  • Semi-rigid Ureteroscopy: This involves a semi-rigid ureteroscope, suitable for straightforward cases or when a more rigid instrument is necessary for stone fragmentation or tissue biopsy.
  • Laser Lithotripsy: Coupled with ureteroscopy, laser energy is used to fragment kidney or ureteral stones into smaller pieces for removal.
  • Basket Retrieval: Involves using a basket-like device inserted through the ureteroscope to grasp and remove smaller stones or stone fragments.
  • Ureteral Stent Placement: Ureteroscopy may also be used to place ureteral stents to relieve obstruction or maintain urinary flow in strictures or blockages.

Why Do You Need Ureteroscopy?

  • Kidney Stones: Ureteroscopy is indicated for diagnosing and treating kidney stones located in the ureter or kidney, particularly those that cannot be effectively managed with other methods like shock wave lithotripsy.
  • Ureteral Stones: It is used to manage ureteral stones that have failed to pass spontaneously or are causing symptoms such as severe pain or urinary obstruction.
  • Ureteral Strictures: Ureteroscopy can diagnose and treat ureteral strictures or narrowings that may obstruct urinary flow.
  • Tumors: It enables visualization and biopsy of ureteral or renal tumors for diagnostic purposes.
  • Urological Evaluation: Ureteroscopy may be performed to evaluate the urinary tract for abnormalities such as congenital anomalies or recurrent urinary tract infections.

How Are Patients Selected For The Procedure?
Patient selection for Ureteroscopy involves a thorough evaluation by a urologist. Factors considered include the size, location, and composition of urinary tract abnormalities such as kidney stones or tumors and the patient's overall health status and anatomy. Imaging studies like CT scans or ultrasound help assess the severity and extent of the condition. Shared decision-making between the patient and healthcare provider ensures informed consent and personalized treatment plans tailored to individual needs. Collaboration with multidisciplinary teams facilitates comprehensive assessments, optimizing patient selection and treatment outcomes while considering risks, benefits, and alternatives to Ureteroscopy.

Risks And Benefits Associated With The Chosen Ureteroscopy
Risks of Ureteroscopy:

  • Infection: Potential risk of urinary tract infection or systemic infection following the procedure.
  • Bleeding: Risk of bleeding during or after the surgery, particularly in patients on anticoagulant medications or with bleeding disorders.
  • Ureteral Injury: Possibility of injury to the ureter or surrounding structures during the insertion of the ureteroscope.
  • Residual Stones: Some stones may remain after the procedure, requiring additional interventions for complete clearance.
  • Stricture Formation: Rare risk of ureteral stricture formation, leading to urinary obstruction or recurrent symptoms.

Benefits of Ureteroscopy:

  • Precise Diagnosis: Ureteroscopy allows direct visualization and biopsy of urinary tract abnormalities, facilitating accurate diagnosis.
  • Stone Removal: Effective removal of kidney or ureteral stones, relieving symptoms and preventing complications.
  • Minimal Invasiveness: A minimally invasive approach reduces trauma, postoperative pain, and recovery time compared to open surgery.
  • High Success Rates: Ureteroscopy offers high stone clearance rates, particularly for small to medium-sized stones.
  • Shorter Recovery: Shorter hospital stays and faster recovery compared to traditional surgical approaches.

Recovery And Rehabilitation After The Ureteroscopy?
Recovery after Ureteroscopy involves several stages. Initially, patients may experience mild urinary symptoms such as frequency, urgency, or discomfort, which are managed with medications. Follow-up appointments monitor progress, and stent removal may be necessary. Gradual improvement follows as the urinary tract heals. Full recovery typically takes several days to weeks, with most patients resuming normal activities within a short time. Pelvic floor exercises may aid in urinary control. Adhering to post-operative instructions, including hydration and dietary recommendations, is crucial for optimal recovery. Prompt reporting of unusual symptoms to healthcare providers ensures timely intervention and prevents complications.

What To Expect After Ureteroscopy? 
After a Ureteroscopy, expect relief from symptoms such as pain or discomfort related to urinary tract abnormalities. However, temporary urinary symptoms such as urgency, frequency, or discomfort may persist during healing. Follow-up appointments monitor progress, and stent removal may be necessary. Gradual improvement follows as the urinary tract heals, with most patients experiencing significant relief and improved quality of life within a few weeks. Adhering to post-operative instructions, including hydration, dietary modifications, and prescribed medications, is crucial for optimal recovery and long-term urinary health. Prompt reporting of any concerning symptoms to healthcare providers ensures timely intervention.

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Frequently Asked Questions

The duration of Ureteroscopy varies depending on factors such as the complexity of the case and the specific procedure performed. Generally, the procedure takes between 30 minutes to 1 hour, though it may extend longer for more complicated cases.

The success rate of Ureteroscopy for stone clearance is generally high, ranging from 70% to 90%. However, outcomes depend on stone size, composition, and patient characteristics. Additional interventions may be needed for residual stones or complications.

After ureteroscopy, initial urinary symptoms may persist, but they are managed with medications. Follow-up appointments monitor progress, and stent removal may be necessary. Gradual improvement follows as the urinary tract heals. Full recovery typically takes several days to weeks, with patients gradually resuming normal activities. Pelvic floor exercises may aid urinary control.

Returning to normal activities after Ureteroscopy varies based on individual healing and the extent of the procedure. Generally, patients can resume light activities within a few days but may require several weeks to engage in heavy tasks or exercise fully.

After Ureteroscopy, maintaining hydration, following a balanced diet, and avoiding excessive salt intake may be advised to prevent stone recurrence. Regular follow-up appointments and adherence to prescribed medications are essential for monitoring kidney health and preventing future urinary tract issues.

Alternative treatments for urinary tract conditions include shock wave lithotripsy (SWL) for smaller stones, medical expulsive therapy (MET) for stone passage, or percutaneous nephrolithotomy (PCNL) for larger or more complex stones. However, Ureteroscopy remains a primary option for direct visualization and treatment of urinary tract abnormalities.

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