Ureteroscopy for kidney and ureteric stones: what happens, risks and recovery

The NHS explains that small kidney stones are common, may cause no symptoms, and can be passed in the urine without being noticed. Most stones are managed at home with medicine for the pain, which is why surgeons do not rush to operate on every stone seen on a scan.

Ureteroscopy comes into the conversation when a stone is stuck in the ureter and causing severe colic, when it is not moving, when it is blocking the kidney, or when there is infection behind it. It is also used for stones that sit inside the kidney itself and have not been able to leave. A trust leaflet describes it as a way to treat larger stones that will not pass naturally.

• A stone that is small and moving down is often watched rather than treated.

• A stone with fever, shivering or a blocked kidney is treated as urgent, usually with a stent or drain first and the stone dealt with later.

• The choice between telescope surgery and shockwave treatment depends on stone size, position and hardness, and on your own health.

Shockwave lithotripsy breaks the stone from outside the body and is covered in its own guide in this section. NHS wording is that it needs no anaesthetic and you are awake. Percutaneous nephrolithotomy is a larger keyhole operation through the back that is kept for big or complex kidney stones. Open surgery is now rare.

Waiting with pain relief and plenty of fluids remains a genuine option when a stone is small and you are otherwise well. If you have only one working kidney, a weakened immune system or are pregnant, the balance changes and the team will explain why.

Trust leaflets describe a pre-assessment visit in which your general health is checked, a swab for MRSA may be taken, and tests such as a urine sample, blood tests or an X-ray are done. A urine infection is usually treated before surgery because operating through an infected system raises the chance of becoming unwell afterwards.

You will be told when to stop eating and drinking. One leaflet gives six hours without food before surgery and another gives a window of four to six hours; follow the instruction on your own letter, because it reflects how your hospital runs its lists. Tell the team about blood thinners, antiplatelet tablets, diabetes medicines and any allergy, and ask whether to stop anything beforehand.

• Bring your medicine list and any letters about the stone.

• Arrange for an adult to take you home and to be around for the first night if you are discharged the same day.

• Smoking and a cough increase anaesthetic risk, so cutting down beforehand is worth discussing at pre-assessment.

You are usually admitted on the morning of surgery, change into a gown, meet the anaesthetist and surgeon, and are checked against your consent form. Most people have a general anaesthetic given through a cannula in the back of the hand, and you are asleep throughout.

Once you are asleep, the surgeon passes a fine telescope through the urethra into the bladder and up the ureter, often using X-ray screening and a guidewire. If the stone is small it can be gripped in a tiny basket and withdrawn. If it is larger, a laser fibre is passed through the telescope to break it into fragments, which are then removed or left small enough to pass. A flexible telescope is used to reach stones inside the kidney.

At the end a stent is often placed. Leaflets do not give one fixed operating time, because it depends on the size and position of the stone, so ask your team what to expect.

A stent is a thin flexible tube that keeps the ureter open while swelling settles. Trust leaflets list the usual stent symptoms: needing to pass urine more often and more urgently, stinging, blood in the urine, an ache in the bladder or loin, and sometimes pain at the tip of the penis or a cystitis-like feeling that is worse when passing urine.

Pain in the kidney area can last for several days; one trust says at least 72 hours. Anti-inflammatory painkillers are often suggested if you can take them, with plenty of fluids to flush out fragments and keep bleeding light. Some trusts remove the stent within days using an attached string, others bring you back for a short telescope check under local anaesthetic, so find out which applies to you before you leave.

Trust leaflets agree on the main points. Common effects are mild burning and blood in the urine for a short time and stent symptoms. Infection of the urine is the most frequent complication and is the reason antibiotics are often given. Other recognised risks are failure to reach or clear the stone, stone fragments left behind, stones forming again in future, and a further procedure to remove or change the stent.

Less common but more serious risks include injury to the ureter, later scarring or narrowing of the ureter, and a spreading infection that needs admission. One trust leaflet quotes about 3 in 100 patients for infection and under 1 per cent for ureteric injury; those figures are that leaflet's own and other hospitals may quote different ones. General anaesthetic risks, such as chest infection and blood clots, apply as for any operation.

After you go home, call your hospital ward or stone team, or your GP out of hours via NHS 111, if you have a fever or shivering, severe pain not controlled by your painkillers, heavy bleeding with clots, or you cannot pass urine. Trust leaflets list the same signs.

If you feel very unwell, are confused, or are faint with a high temperature, go to A&E or call 999, because a blocked, infected kidney can become serious quickly.

Useful questions are: Will I need a stent and when will it come out? Is a general or spinal anaesthetic planned? What happens if the stone cannot be reached the first time? How can I lower the chance of another stone, and will the stone be analysed?

The operation itself is the same in the NHS and private hospitals. Differences tend to lie in how soon you can be listed, whether you see the same surgeon throughout, and what is included in the price, so ask for the fee to be itemised including a stent removal visit and any follow-up scan.