Endoscopic surgery for kidney stones is a minimally invasive approach in which a specialist uses a thin camera-equipped instrument to enter the urinary tract and reach a stone.

Unlike traditional open surgery, the scope is generally introduced through the natural urinary passage. Depending on the stone's location, size and characteristics, the stone can be removed with a small instrument or fragmented using laser energy.

One of the most commonly used endoscopic approaches is ureteroscopy (URS). When a flexible scope is advanced into the kidney to treat renal stones, the procedure may be referred to as flexible ureteroscopy or RIRS (retrograde intrarenal surgery).

Endoscopic treatment can be considered for selected kidney and ureteric stones when spontaneous passage is unlikely, symptoms persist, obstruction occurs or active stone removal is otherwise appropriate.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides kidney-function assessment and specialist kidney care and can coordinate appropriate evaluation when stone disease affects kidney health.

When Is Endoscopic Kidney Stone Surgery Considered?

Not every kidney stone requires an operation.

Small stones may sometimes pass naturally, depending on their size and location. However, active treatment may be considered when a stone:

• Is unlikely to pass naturally

• Causes persistent or severe symptoms

• Produces urinary obstruction

• Causes recurrent infection

• Is increasing in size

• Affects kidney function

• Remains despite conservative treatment

• Requires removal because of its location or clinical circumstances

Treatment decisions depend on imaging, stone characteristics and the patient's overall condition.

How Does Endoscopic Stone Removal Work?

The basic procedure involves reaching the urinary tract through the urethra and bladder.

A typical ureteroscopic stone procedure may involve:

1. Anesthesia is administered according to the planned procedure.

2. A thin ureteroscope is passed through the urethra into the bladder.

3. The scope is guided into the ureter and, when required, toward the kidney.

4. The stone is identified using the camera and imaging guidance.

5. A small basket or other instrument may remove suitable stone fragments.

6. Laser energy may be used to break a larger stone into smaller pieces.

7. Selected fragments are removed or allowed to pass naturally.

8. A temporary ureteral stent may be placed when appropriate.

Ureteroscopy is generally performed under anesthesia, and many procedures can be completed as day-care or short-stay treatment depending on the case.

What Is Laser Treatment During Endoscopic Surgery?

Laser lithotripsy is commonly used during ureteroscopy to fragment a kidney or ureteral stone.

The laser is delivered through a small working channel in the endoscope.

Depending on the stone and the surgical plan, the surgeon may:

• Break the stone into several pieces

• Fragment it into very small particles

• Remove larger fragments with a basket

• Treat multiple stones during the same procedure when appropriate

Laser treatment does not mean that every stone will require exactly the same technique. Stone size, hardness, location and kidney anatomy influence the approach.

What Is RIRS?

RIRS, or retrograde intrarenal surgery, is a form of flexible endoscopic stone treatment.

A flexible ureteroscope can be advanced through the urinary tract into the kidney, allowing the surgeon to inspect different parts of the collecting system.

Laser energy may then be used to fragment renal stones.

RIRS can be particularly useful for selected stones located within the kidney when a minimally invasive endoscopic approach is appropriate.

The suitability of RIRS depends on factors such as:

• Stone size

• Number of stones

• Stone location

• Stone density

• Kidney anatomy

• Previous procedures

• Infection status

• Patient health

Is Endoscopic Surgery Better Than Shock Wave Lithotripsy?

There is no single procedure that is best for every kidney stone.

Shock wave lithotripsy (SWL/ESWL) uses externally generated shock waves to fragment stones, while endoscopic surgery reaches the stone directly through the urinary tract.

The choice may depend on:

• Stone size

• Stone location

• Stone density

• Kidney anatomy

• Body habitus

• Urinary obstruction

• Infection

• Previous treatment

• Expected likelihood of complete stone clearance

Your urologist can compare the options after reviewing the imaging.

Endoscopic Surgery Versus PCNL

For larger or complex kidney stones, percutaneous nephrolithotomy (PCNL) may be more appropriate than ureteroscopy in some patients.

PCNL reaches the kidney through a small access tract created through the back, whereas endoscopic ureteroscopy uses the natural urinary passage.

A specialist may consider:

• Total stone burden

• Stone size

• Location

• Anatomy

• Infection

• Kidney function

• Previous procedures

• Expected stone-free rate

Large stones do not automatically mean that endoscopic ureteroscopy is impossible, but some patients may need PCNL or a staged treatment strategy.

Can Large Kidney Stones Be Treated Endoscopically?

Selected larger stones can be treated using flexible ureteroscopy, but the size and overall stone burden are important.

For a large stone, treatment may require:

• A longer procedure

• More than one ureteroscopy

• Staged treatment

• A different procedure such as PCNL

• A combination of techniques

The objective is not simply to perform the least invasive procedure but to select a treatment that offers a reasonable balance between effective stone clearance and procedural safety.

What Tests Are Needed Before Endoscopic Stone Surgery?

Before stone removal, the treating team may review imaging and laboratory results.

Imaging

Ultrasound or CT may be used to determine:

• Stone size

• Stone location

• Number of stones

• Degree of obstruction

• Kidney anatomy

A CT scan can provide detailed information that helps with procedural planning.

Urine Testing

Urinalysis and, when appropriate, urine culture can help identify infection.

A known urinary infection may need appropriate treatment before definitive stone removal.

Blood Tests

Depending on the patient's condition, testing may include:

• Creatinine

• eGFR

• Electrolytes

• Hemoglobin

• Other relevant tests

Kidney function is particularly important when a patient already has CKD, obstruction or other medical problems.

What Happens If the Stone Is Blocking Urine?

A blocked urinary tract requires careful assessment.

If obstruction is associated with infection, fever, chills, sepsis or inability to pass urine, it can become an emergency.

In such circumstances, the immediate priority may be restoring urinary drainage rather than performing definitive stone fragmentation immediately.

Drainage may involve a ureteral stent or nephrostomy, followed by definitive stone treatment once the acute infection has been appropriately managed.

Patients with severe stone symptoms, infection or urinary obstruction should seek urgent medical attention.

Is a Ureteral Stent Always Required?

No.

A stent is not necessarily required after every ureteroscopy.

However, a temporary stent may be placed when the treating urologist believes it will help:

• Maintain urine drainage

• Reduce the effect of ureteral swelling

• Allow stone fragments to pass

• Support healing

• Reduce the risk of postoperative obstruction

A stent can cause temporary urinary frequency, urgency, discomfort or blood in the urine.

The treating doctor should provide a clear plan for its removal or exchange.

What Does Recovery After Endoscopic Kidney Stone Surgery Look Like?

Recovery depends on the complexity of the procedure and whether a stent was placed.

Some patients experience temporary:

• Burning while urinating

• Urinary urgency

• Increased frequency

• Mild blood in urine

• Flank discomfort

• Bladder discomfort

• Passage of small stone fragments

Many uncomplicated ureteroscopic procedures allow patients to return home the same day, although recovery recommendations vary.

Follow your treating specialist's instructions regarding medicines, activity, fluids and follow-up.

How Long Does It Take to Recover?

There is no single recovery period for every patient.

Recovery can depend on:

• Stone size

• Number of stones

• Location

• Duration of surgery

• Whether laser fragmentation was required

• Whether a stent was inserted

• Presence of infection

• General health

A simple procedure may involve relatively quick recovery, while complex or staged stone treatment can require more follow-up.

What Are the Possible Risks of Endoscopic Kidney Stone Surgery?

Endoscopic stone surgery is generally minimally invasive, but complications can occur.

Possible risks include:

• Urinary tract infection

• Bleeding

• Pain or burning during urination

• Temporary urinary symptoms

• Ureteral irritation or injury

• Stone fragments remaining after treatment

• Stent-related discomfort

• Need for another procedure

• Anesthesia-related complications

Ureteroscopy can rarely cause more significant urinary tract injury or narrowing.

The individual risk depends on the patient's anatomy, stone characteristics, infection status and the complexity of the procedure.

What Symptoms After Surgery Need Medical Attention?

Contact the treating medical team promptly if you develop:

• Fever or chills

• Severe or worsening pain

• Inability to urinate

• Heavy or persistent bleeding

• Blood clots in urine

• Severe weakness

• Persistent vomiting

• Sudden deterioration in health

Fever following ureteroscopy can indicate infection and should not be ignored.

Can Endoscopic Surgery Completely Remove Kidney Stones?

The goal is usually to achieve the best possible stone clearance safely.

However, complete clearance is not guaranteed after one procedure.

The likelihood depends on:

• Stone burden

• Stone density

• Location

• Kidney anatomy

• Number of stones

• Procedure selected

Large or multiple stones may require staged procedures.

Follow-up imaging can help determine whether residual fragments remain.

What Happens to the Stone After Removal?

If fragments are retrieved, the stone may be sent for laboratory analysis.

Knowing the stone composition can help identify why it formed and guide prevention strategies.

Depending on the clinical situation, the doctor may also recommend metabolic testing, including urine evaluation, to identify factors that increase the risk of future stones.

How Can You Prevent Another Kidney Stone?

Removing a stone treats the existing problem, but it does not necessarily remove the factors responsible for stone formation.

Prevention may involve:

• Appropriate fluid intake

• Reducing excessive sodium

• Maintaining a balanced diet

• Avoiding unnecessary dietary restrictions

• Taking prescribed preventive medicines

• Stone analysis when available

• Metabolic evaluation for selected patients

• Regular follow-up

Fluid recommendations should be individualized, especially for people with CKD, heart disease or fluid restrictions.

Who Performs Endoscopic Kidney Stone Surgery?

Endoscopic stone removal is generally performed by a urologist, who specializes in surgical conditions of the urinary tract.

A nephrologist specializes in medical kidney diseases, kidney function, electrolyte disorders, dialysis and transplant medicine.

Some patients benefit from coordination between urology and nephrology, particularly when stone disease is associated with:

• Reduced kidney function

• CKD

• Recurrent stones

• Significant proteinuria

• Electrolyte abnormalities

• Diabetes or hypertension

• Previous kidney transplantation

Endoscopic Kidney Stone Evaluation at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized kidney evaluation for patients with stone disease and associated kidney-function concerns.

Depending on the patient's condition, evaluation may include:

• Review of kidney stone imaging

• Assessment of creatinine and eGFR

• Evaluation of urinary obstruction

• Review of urine and infection reports

• Assessment of recurrent stone disease

• Kidney-function monitoring

• Evaluation of associated CKD

• Medical management of kidney-related complications

• Coordination with appropriate urological specialists when endoscopic stone removal is indicated

The most appropriate stone-removal procedure depends on the stone's characteristics and the patient's overall health.

Frequently Asked Questions

What is endoscopic surgery for kidney stones?

It is a minimally invasive method in which a thin camera-equipped instrument is passed through the urinary tract to reach, fragment or remove a kidney or ureteral stone. Ureteroscopy is a common endoscopic approach.

Is laser used during endoscopic kidney stone surgery?

Yes. Laser energy can be delivered through a ureteroscope to break a stone into smaller fragments that can be removed or passed through the urinary tract.

Is endoscopic kidney stone surgery painful?

The procedure is performed with anesthesia, so significant pain during the operation is prevented. Temporary discomfort, urinary burning, urgency or flank discomfort can occur afterward, particularly when a stent is present.

Is a stent necessary after ureteroscopy?

Not always. A temporary stent may be placed when the surgeon believes it is needed to maintain drainage, accommodate swelling or facilitate recovery.

Can a 10 mm or larger kidney stone be treated with endoscopy?

Selected stones of this size can be treated endoscopically, but the decision depends on location, density, anatomy, stone burden and patient factors. Larger or complex stones may be better suited to PCNL or staged treatment.

How long does endoscopic kidney stone surgery take?

Procedure time varies considerably depending on the stone's number, size, location and complexity. Your treating urologist can provide a more accurate estimate after reviewing imaging.

Can kidney stones come back after endoscopic surgery?

Yes. Stone removal does not eliminate the metabolic or dietary factors that caused the stone. Stone analysis and preventive evaluation can help reduce recurrence risk.

Is endoscopic surgery better than ESWL?

Neither treatment is universally better. The appropriate option depends on the stone's size, location, composition, anatomy and other clinical factors.

Conclusion

Endoscopic surgery for kidney stones provides a minimally invasive way to reach and treat selected stones in the ureter or kidney. Ureteroscopy and flexible ureteroscopy can allow direct visualization of the urinary tract, while laser lithotripsy can fragment stones into smaller pieces.

The right procedure depends on more than stone size alone. Location, number, density, obstruction, infection, kidney anatomy, kidney function and overall health all influence treatment planning.

Some patients may be suitable for ureteroscopy or RIRS, while others may benefit from ESWL, PCNL or staged treatment. When infection occurs together with urinary obstruction, urgent drainage and medical management may take priority over definitive stone removal.

For kidney-function assessment and specialist management of associated kidney conditions, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic. Where a surgical stone procedure is required, appropriate urological coordination can be arranged.

Medical Disclaimer

This article is intended for general educational and informational purposes only and should not be considered a substitute for professional medical diagnosis, treatment or individualized medical advice. Endoscopic kidney stone treatment is not appropriate for every patient, and the choice between ureteroscopy, RIRS, ESWL, PCNL or other approaches depends on stone size, location, composition, obstruction, infection status, kidney anatomy and overall health. Endoscopic stone removal is generally performed by a qualified urologist. Do not delay medical assessment if you have severe stone pain, fever, chills, persistent vomiting, very little or no urine or rapidly worsening symptoms. Do not start or stop medicines or alter fluid intake without medical guidance. Consult Dr. Sandip Prabhakar Bhurke or another qualified healthcare professional for an individualized treatment plan.