Semi-rigid ureteroscopy (URS)

What the procedure involves

Under general anaesthetic, a cystoscope is first used to see the inside of the bladder and locate the opening of the ureter. A thin semi-rigid ureteroscope - around 8 to 10 French (roughly 3 mm in diameter) - is then passed up the ureter to the stone.

The stone is broken up with a Holmium:YAG laser, which is delivered down a flexible laser fibre through the working channel of the ureteroscope.¹ Fragments are retrieved with a dedicated Dormia basket wherever stone size and anatomy allow - Dr Kooner's standard approach is active extraction rather than leaving fragments to pass on their own.

A temporary ureteric stent is usually placed at the end to reduce post-operative pain and swelling while the ureter recovers. Most patients go home the same day or the next morning.

Who it suits best

• Ureteric stones in the lower ureter (distal to the iliac vessels).
• Selected mid-ureteric stones.
• Stones of almost any density - including cystine and dense calcium oxalate.
• Patients on anticoagulation, because it avoids renal puncture and shockwave energy (often performed without interrupting anticoagulants, on cardiology advice).²

Success rates

A meta-analysis of 24 studies (2,058 patients) with proximal ureteric stones treated by semi-rigid ureteroscopy and Holmium laser reported a pooled single-session stone-free rate of 78% (95% CI 75-82%).³ For distal ureteric stones, stone-free rates of 90% or higher are commonly achieved.

The admission

1. Pre-admission checks

   Fasting for 6 hours. Urine culture must be clear. Any anticoagulation is managed according to cardiology advice.

2. The procedure

   General anaesthetic. Usually 45-90 minutes depending on stone size and location.

3. Recovery & discharge

   Same-day discharge is common. Simple oral analgesia for 3-7 days. Most people drive again once off opioids.

4. Stent removal

   The stent is removed 7-14 days later, usually in the rooms under local anaesthetic gel - a quick office procedure.

5. Follow-up imaging

   At around 4-6 weeks with ultrasound or plain film to confirm the ureter has recovered and there are no residual fragments.

Risks and side-effects

• Stent-related symptoms - frequency, urgency, pink urine, flank discomfort on voiding - in up to 70% of patients while the stent is in place; resolves rapidly after removal.
• Urinary tract infection (around 2-5%).
• Small risk of ureteric injury or perforation, which may require a longer stent and a delayed second-look procedure.
• Rare long-term risk of ureteric stricture (scarring), especially with very dense impacted stones or high laser energy.⁴

Patient information brochure

Ureteroscopy for stone(s) PDF - BAUS patient brochure Advice to patients with a ureteric stent PDF - BAUS patient brochure

Related pages

References

1. Kim HJ, Ghani KR. Which is the best laser for lithotripsy? Holmium laser. European Urology Open Science. 2022;44:27-29.
2. Singh D. High-powered laser platforms expand ureteroscopic options for complex patients, including those on anticoagulation. Urology Times. 2026.
3. Shi Y, et al. Semi-rigid ureteroscopy with Holmium:YAG laser for proximal ureteric calculi. European Urology Open Science. 2024;70:124-134.
4. Villani M, et al. High-power laser settings and ureteral stricture risk in ureteroscopic lithotripsy. World Journal of Urology. 2025.