Understanding Ureteroscopy (URS) for Kidney Stones

 In this blog, I explain everything you need to know about ureteroscopy (URS)—what it is, how it works, and when it's recommended. We’ll go over how this procedure compares to shock wave lithotripsy, who qualifies for it under AUA guidelines, and what the real-world success rates look like. If you’ve been told you might need ureteroscopy, this blog will prepare you for the conversation.

Key Takeaways:

• Ureteroscopy is a minimally invasive option for treating stones in the ureter and kidney

• It uses either laser or pneumatic energy to break up stones

• Higher stone-free rates than shock wave lithotripsy, but with more complications

• Recommended when other treatments fail or for certain complex or special-case patients

If you’ve been told that ureteroscopy—or URS—might be your next step in treating a kidney stone, you’re probably wondering what the procedure involves.

In this blog, I’ll break down what ureteroscopy is, how it works, who qualifies for it, and how it stacks up in terms of success rate, safety, and cost.

What Is Ureteroscopy?

Ureteroscopy is a minimally invasive surgical procedure used to remove or break apart kidney stones. It involves inserting a device called a ureteroscope into the urinary tract.

There are two main approaches:

• Retrograde: Through the urethra, bladder, and up the ureter (used most often)

• Antegrade: Through a small incision in the side into the kidney (rare, used only in specific cases)

Once the scope reaches the stone, the surgeon uses either a laser or pneumatic lithotripter to break it into smaller pieces or grabs it with a stone basket and removes it entirely.

Energy Sources Used in Ureteroscopy

There are two major energy types for breaking apart stones during ureteroscopy:

1. Laser Lithotripsy

   • Common in more developed countries

   • Offers precise control but comes at a higher cost

2. Pneumatic Lithotripsy

   • Older and less expensive

   • Still effective, but may not be as refined as laser technology

Sometimes, no energy source is used at all. In simpler cases, a surgeon may simply extract the stone using a basket if it’s loose and reachable.

Flexibility and Reach

One of the biggest strengths of ureteroscopy is that it can be used almost anywhere in the urinary system.

It doesn’t matter what the stone type, location, or density is—ureteroscopy can usually get to it. That flexibility makes it a very popular choice in modern urology.

Procedure Costs

Compared to other options like shock wave lithotripsy, ureteroscopy is a bit more expensive upfront, but also more effective in a single session.

• Average cost: ~$2,700 per session

• Most patients require two sessions for complete clearance

So, while it’s not the cheapest, it offers a better shot at getting everything cleared faster.

Complications to Know About

With better clearance rates comes a trade-off: higher risk of complications.

Compared to shock wave lithotripsy, which is non-invasive and has fewer side effects, ureteroscopy can lead to:

• Hematuria (blood in urine)

• Infection

• Fever

• Damage to the ureter

According to the data, nearly 60% of patients may experience some kind of complication.

When Is Ureteroscopy Used?

The American Urological Association outlines several scenarios where URS is preferred.

For Ureteral Stones (<10mm)

• First, most people try expulsive therapy (medical or natural)

• If that fails—or if shock wave lithotripsy fails—ureteroscopy is the next step

For Kidney Stones
It depends on the stone’s location and size.

• Non-lower pole stones <20mm → URS is effective

• Lower pole stones <10mm → URS is an option, especially if the stone can be moved to a more accessible area using a basket

• Calyceal diverticular stones → URS allows direct visualization and access

• Patients who can’t have PCNL (e.g., on blood thinners, pregnant women) → URS is often safer

Success Rates After Ureteroscopy

Here’s where ureteroscopy really shines—stone-free rates are generally higher than those for shock wave lithotripsy.

These numbers are based on pooled results from 40–50 studies and reflect clearance after two procedures.

By Stone Location:

• Upper ureter: 92%

• Renal pelvis: 83%

• Upper pole: 85%

• Middle pole: 85%

• Lower pole (not relocated): 61%

Lower pole stones are difficult to access, which explains the steep drop in success rate for that region. When surgeons relocate those stones to a more favorable area, outcomes improve.

By Stone Size:

• <10mm: 80%

• 10–20mm: 83%

Stones over 20mm are rarely treated with URS because it’s simply not the best fit. In those cases, percutaneous nephrolithotomy or laparoscopic surgery is usually a better choice.
 

Final Thoughts: Is Ureteroscopy Right for You?

Ureteroscopy is a versatile, effective, and minimally invasive way to treat a wide range of kidney and ureteral stones.

It gives surgeons flexibility, patients fast relief, and works well even when other treatments fail.

Just remember, the trade-off for better outcomes is a higher chance of complications—and likely more than one session to get completely stone-free.

Now that you understand the ins and outs of this procedure, you’ll be more prepared to talk to your urologist and make informed decisions about your care.

Whether you're just starting to explore your options or preparing for your second round of treatment, this blog should help guide your next step.