When a ureter stone needs URSL
A small ureteric stone may pass with medical expulsive therapy over two to four weeks. When it does not move, or when the pain, vomiting or kidney swelling will not settle, leaving it in place risks damaging the kidney above it.
- Stone above 6 mm, or impacted for more than four weeks
- Colic that returns despite medication
- Fever or infected urine with an obstructing stone
- Hydronephrosis on ultrasound
- Single kidney, or a stone on both sides
- Professions where sudden colic is unsafe — drivers, pilots, surgeons
The procedure
A thin scope is passed up through the urethra and bladder into the ureter. The stone is fragmented with a holmium laser or pneumatic probe and the pieces are removed with a basket, so you are not left waiting for fragments to pass. A DJ stent is usually placed for a week or two so the ureter, which has been inflamed by the stone, can drain freely while it settles.
Recovery
URSL is often a day-care procedure. Burning while passing urine and a small amount of blood are normal for two to three days. Most patients return to work within 48 hours. The stent removal afterwards takes a couple of minutes in the OPD and does not need anaesthesia.
URSL / Ureteroscopy — common questions
How long does a ureter stone take to pass on its own?
Small stones under 5 mm pass in two to four weeks in most people. Beyond six weeks, an impacted stone starts to scar the ureter wall, which is why waiting indefinitely is not advised.
Is URSL done under general anaesthesia?
Usually spinal or short general anaesthesia. You will be awake and comfortable within an hour of the procedure ending.
Why is a DJ stent needed after URSL?
The ureter swells where the stone was sitting. The stent keeps urine draining from the kidney while that swelling settles and prevents a painful post-operative blockage.
Can URSL treat a stone near the kidney?
Upper ureteric stones can sometimes push back into the kidney during the procedure. When that happens, a flexible scope (RIRS) is used in the same sitting to finish the job.
Reviewed by Dr. Kinjal Banerjee, MBBS, MS (General Surgery), DNB (Urology) — Urologist, Renal Transplant & Robotic Surgeon, Faridabad. This page explains ursl / ureteroscopy in general terms; your own treatment plan depends on your reports and examination.