Kidney stone removal (ureteroscopy)
A keyhole operation that passes a thin telescope up the natural urine tubes to break up or remove a stone in the kidney or ureter, usually with a laser.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Ureteroscopy treats a stone you already have by passing a thin telescope up the natural waterpipe with no cuts on the skin, usually breaking it up with a laser. It does not stop new stones forming, so the reason your body made a stone still needs looking into.
- Most people need a temporary internal tube (a ureteric stent) for a short time afterwards. It commonly causes bladder discomfort, a frequent urge to pass urine and a little blood, which settles once the stent is removed.
- Expect some stinging or a little blood when passing urine and mild discomfort for a few days, and drink plenty of fluids. A high temperature, severe pain or being unable to pass urine can signal infection or a blockage: call 999 or go to A&E if it is severe or you feel very unwell, otherwise get urgent advice from NHS 111 (in England, Scotland and Wales) or, in Northern Ireland, your GP out-of-hours service or your HSC Trust's Phone First service.
- It is usually a day case or one overnight stay, and a follow-up scan is often needed to confirm the stone has fully cleared. Ask your surgeon whether all of the stone was removed and whether a stent was left in.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can clear most of the stone in a single operation
You have an untreated urine infection — this should be cleared first to reduce the risk of serious infection.
Expect some blood in the urine and stinging when passing urine. Drink plenty of fluids unless told otherwise. A stent may cause urgency and bladder or...
Clear written instructions on stent symptoms and a firm date for removal.
Expect some blood in the urine and stinging when passing urine. Drink plenty of fluids unless told otherwise. A...
Discomfort settles for most people. Many return to light work within a few days to a week. Stent symptoms can come...
If a stent was left, it is removed in clinic, usually with a small flexible camera. Symptoms from the stent...
A check scan or X-ray is often arranged to confirm the stone has cleared and the kidney is draining well.
What it is
Ureteroscopy is a keyhole way of dealing with a stone in the kidney or the ureter (the tube between kidney and bladder). The surgeon passes a thin telescope up through the waterpipe (urethra) and bladder, with no cuts on the skin, and uses a laser to break the stone into tiny pieces or a small basket to pull it out.
It is one of the main treatments for stones that are too big to pass on their own, that are causing pain or blockage, or that have not cleared with other treatments. A flexible scope can reach stones inside the kidney; a rigid scope is used lower down the ureter.
It treats the stone you have now. It does not stop new stones forming, so the reasons your body made a stone still need looking into. Most people need a temporary internal tube (a ureteric stent) for a short time afterwards, and a follow-up scan to confirm the stone has gone.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Ways to treat a stone
| Approach | How it works | Best suited to |
|---|---|---|
| Ureteroscopy | Telescope up the natural tubes, laser breaks the stone | Ureter stones and many kidney stones; high clearance in one go |
| Shockwave (ESWL) | Sound waves from outside the body break the stone | Smaller stones; no anaesthetic, but may need repeating |
| PCNL (keyhole through the back) | Telescope through a small cut in the back into the kidney | Large or complex kidney stones |
Which option suits you depends on the size, hardness and position of the stone, your anatomy and your kidney function. Your urologist should explain the trade-offs.
Preparing for your surgery
- See the operating urologist, who will review your scans and explain whether ureteroscopy, shockwave treatment or keyhole surgery suits your stone best.
- Give a urine sample beforehand; an active urine infection usually needs treating first to lower the risk of serious infection during surgery.
- Tell the team about all medicines, especially blood thinners, and ask well in advance whether any need pausing.
- Mention diabetes, a single working kidney, an unusual kidney shape or any past stone surgery, as these change the plan.
- You will usually need to fast (no food or drink) for several hours before a general anaesthetic.
- Arrange a lift home and someone with you for the first day, as you cannot drive after a general anaesthetic.
- Ask whether you are likely to wake up with a stent, and what it may feel like.
What happens
The operation is usually done under general anaesthetic, so you are asleep, although a spinal anaesthetic is sometimes used. There are no cuts on your skin.
The surgeon passes the telescope through the waterpipe and bladder and up to the stone. Using X-ray and direct vision, they break the stone with a laser and remove the pieces with a small basket, or leave fine fragments to pass in your urine. A soft internal tube (a ureteric stent) is often left between the kidney and bladder to keep urine draining and reduce swelling; this is removed later.
Most people go home the same day or after one night. You may see blood in your urine and feel some stinging when passing urine for a few days, and a stent can cause an urge to pass urine, bladder discomfort or a twinge in the kidney area.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- You have an untreated urine infection — this should be cleared first to reduce the risk of serious infection.
- The stone is very large or complex, where keyhole surgery through the back (PCNL) may clear it more reliably.
- You are on blood thinners that cannot be safely managed around the operation.
- Your anatomy or a very tight ureter means the telescope cannot be passed, so a staged approach with a stent is needed first.
Delay surgery if…
- You currently have a urine infection or unexplained fever.
- You are or might be pregnant, as X-rays and anaesthetic plans change.
- Your blood-thinning medication has not yet been reviewed.
- You cannot arrange a lift home or someone to stay with you after a general anaesthetic.
- Recent scans are not available to plan the safest approach.
Alternatives to discuss
- Watchful waiting with pain relief if a small stone is likely to pass on its own.
- Shockwave lithotripsy (ESWL), which breaks the stone with sound waves and needs no anaesthetic, though it may need repeating.
- Percutaneous nephrolithotomy (PCNL) for large or complex kidney stones.
- Medical (expulsion) therapy and fluids for some ureteric stones, under specialist advice.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Can clear most of the stone in a single operation
- No cuts on the skin, as it uses the body's natural urine tubes
- Treats stones in the ureter that are blocking the kidney or causing pain
- Can reach stones inside the kidney that shockwave treatment may not clear
- Usually a day case or a single overnight stay
- Lets the surgeon see the stone directly and confirm it has been dealt with
Risks & complications
- Blood in the urine for a few days
- Stinging or discomfort when passing urine
- Stent symptoms: urgency, frequency, bladder discomfort or a tug in the kidney area
- Mild flank (kidney area) pain or feeling bruised inside
- Urine infection or fever needing antibiotics
- Not all the stone being cleared, so a further treatment is needed
- A small tear (perforation) of the ureter, sometimes meaning a stent is left longer
- Being unable to pass the telescope, so a stent is placed and the operation repeated later
- Serious infection or urosepsis, which can make you very unwell
- Scarring and narrowing (stricture) of the ureter over time
- Significant injury to the ureter, very rarely needing open or further surgery
The two things to watch are infection and not clearing the whole stone. An untreated urine infection beforehand raises the risk of serious infection during surgery, so it should be checked first. Ask your surgeon how much stone they expect to clear in one go, whether you will need a stent and for how long, and how they will confirm the stone has gone.
Published figures to discuss
Stone-clearance and complication rates vary with the size, hardness and position of the stone, your anatomy and the equipment used. The figures below are cautious bands drawn from UK patient information and reviews; your own risk depends on your circumstances and your surgeon's experience.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Stone successfully cleared | Over 90% in many series, lower for large or upper-kidney stones | Lower ureteric stones are generally the most straightforward; stones high in the kidney are the hardest to clear completely. | Risk factors for UTI and bleeding after flexible ureteroscopy — PMCncbi.nlm.nih.govPublished figure |
| Urine infection or fever | About 1 in 10 to 1 in 50 (BAUS leaflet band) | Reduced by treating any infection beforehand and giving antibiotics at the time of surgery. | Risk factors for UTI and bleeding after flexible ureteroscopy — PMCncbi.nlm.nih.govPublished figure |
| Need for a further procedure | About 1 in 10 to 1 in 50 (BAUS leaflet band) | Usually because not all the stone was cleared, or the ureter was too tight to pass the scope. | Risk factors for UTI and bleeding after flexible ureteroscopy — PMCncbi.nlm.nih.govPublished figure |
| Tear (perforation) of the ureter | Roughly 1 in 50 to 1 in 100 (BAUS leaflet band) | Often managed by leaving a stent in for longer. | Risk factors for UTI and bleeding after flexible ureteroscopy — PMCncbi.nlm.nih.govPublished figure |
| Narrowing (stricture) of the ureter | Rare, around 1 in 100 or less | Can develop later, which is one reason follow-up matters. | Risk factors for UTI and bleeding after flexible ureteroscopy — PMCncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Most people recover from ureteroscopy itself quite quickly, but a ureteric stent, if you have one, is often the main source of discomfort until it is removed.
- Pink or blood-tinged urine for several days
- Stinging or burning when passing urine that eases over the first week
- Stent symptoms such as urgency, going often, or a twinge in the kidney when you pass urine
- Feeling a little tired for a day or two after a general anaesthetic
- Passing small stone fragments or grit in the urine
Aftercare
- Drink plenty of fluids to flush the urinary system, unless your team advises a limit.
- Take any prescribed painkillers; simple painkillers often help stent discomfort.
- Finish any course of antibiotics you are given.
- Avoid heavy lifting and strenuous exercise for a week or two, especially if you have a stent.
- Know the date your stent is due to come out and do not miss it; a forgotten stent can cause serious problems.
- Keep your follow-up scan appointment so the team can confirm the stone has cleared.
- Save any passed fragments if asked, so the stone can be analysed.
- Urine checked for infection before the operation
- Lift home and someone with you for the first day arranged
- Painkillers at home
- Stent removal date written down (if a stent is planned)
- Follow-up scan appointment noted
- Clinic's contact number for problems saved
Scars and how they heal
There are no cuts on the skin with ureteroscopy, so there is no external scar. Healing happens inside the urinary tract. A small risk of internal scarring (a stricture, or narrowing of the ureter) exists over time, which is one reason a follow-up check is sensible.
⚠ Get urgent help if…
- A high temperature, shivering or feeling very unwell — possible serious infection, seek urgent help
- Severe or worsening pain not controlled by painkillers
- Being unable to pass urine at all
- Heavy bleeding or large clots in the urine
- Persistent vomiting so you cannot keep fluids down
- Pain, blood or symptoms that flare badly after a stent is fitted
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the stone is cleared, the kidney drains freely and pain settles. Whether everything is removed in one go depends mostly on the size, number and position of the stones; lower ureteric stones are generally the most straightforward, while stones high in the kidney can be harder to clear completely.
Clearing the stone treats the problem you have now but does not change the tendency to form stones. A normal follow-up scan is reassuring, but new stones can still form in future, which is why looking at causes and prevention matters.
Removing a stone deals with that stone, but many people who have had one stone go on to form others over the years. Investigations into the cause, together with advice on fluids and diet, can lower that risk. Any stent is a temporary measure and must be removed as planned.
Combining with other procedures
Stone surgery is often combined with placing a ureteric stent in the same operation, and sometimes with treating more than one stone at a time. If a stone is very large or complex, a urologist may recommend keyhole surgery through the back (PCNL) instead, either alone or in stages.
Follow-up & long-term care
You will usually have any stent removed within a couple of weeks and a check scan or X-ray a few weeks later to confirm the stone has cleared and the kidney is draining. Many people are then offered tests and advice to reduce the chance of new stones.
- Keep well hydrated day to day, aiming for pale urine, unless advised otherwise.
- Follow any diet advice tailored to the type of stone you formed.
- Attend metabolic tests or stone-analysis appointments if offered.
- Report any return of stone-type pain promptly, as new stones can form.
Revision and secondary surgery reality
- More than one procedure is sometimes needed to clear all the stone, especially if it is large or high in the kidney.
- If the ureter is too tight, a stent is placed first and the operation repeated a few weeks later.
- Forming one stone raises the chance of forming others, so further treatments over the years are possible.
- A check scan confirms clearance; residual fragments may need monitoring or further treatment.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear written instructions on stent symptoms and a firm date for removal.
- A named contact and out-of-hours route for fever, severe pain or inability to pass urine.
- A planned check scan or X-ray to confirm clearance.
- Referral for stone analysis and prevention advice where appropriate.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Surgeon and anaesthetist fees
- Theatre and facility charges, and whether you stay overnight
- Use of a laser fibre, basket and a ureteric stent
- Complexity: stone size, number and position, and whether one or more procedures are needed
- Imaging before and after, and the cost of stent removal in clinic
- Follow-up consultation and any tests into why the stone formed
- The operating surgeon's and anaesthetist's fees
- Theatre, facility and any overnight stay charges
- Cost of the stent and its later removal
- Follow-up scan or X-ray to confirm clearance
- What happens, and what it costs, if a second procedure is needed to clear remaining stone
- Cancellation policy and what is covered if a complication arises
On the NHS? Ureteroscopy is a standard NHS treatment when a stone needs dealing with; people sometimes use private care for faster treatment, choice of timing or a chosen surgeon.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told you may wake up with a stent and what it can feel like.
- No clear plan or date for stent removal — a forgotten stent can cause serious harm.
- Being given an over-optimistic single-operation success rate for a large or complex stone.
- No discussion of alternatives such as shockwave treatment or keyhole surgery.
- No agreed way to confirm the stone has actually cleared afterwards.
Marketing red flags
- Promising the stone will definitely be gone in one operation regardless of its size.
- Describing the operation as completely without risks or pain-free.
- Not mentioning the need for, or discomfort of, a ureteric stent.
- No mention of follow-up imaging or stone-prevention advice.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Given my stone's size and position, is ureteroscopy, shockwave treatment or keyhole surgery best for me?
- How much of the stone do you expect to clear in one operation?
- Will I have a stent, and if so when will it be removed?
- How will you check the stone has gone afterwards?
- What are my personal risks, given my kidney function and any other conditions?
- What can I do to reduce the chance of forming more stones?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will I have any cuts?
Why do I need a stent and will it hurt?
Will the whole stone be gone in one operation?
Is it available on the NHS?
Will it stop me getting more stones?
When can I go back to work?
Where do I get urgent help if something goes wrong after my operation?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Kidney stones: treatment BAUS — Ureteroscopy for stone(s) patient leaflet NICE NG118 — Renal and ureteric stones: assessment and management Ureteroscopy and stones: current status (review) — PMC Risk factors for UTI and bleeding after flexible ureteroscopy — PMC nidirect — urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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