URS kidney stone removal refers to ureteroscopy, a minimally invasive procedure used to examine and treat stones located in the ureter or kidney.

During ureteroscopy, a thin instrument called a ureteroscope is passed through the natural urinary passage into the bladder and then into the ureter or kidney. The stone can be located directly and may be removed with specialized instruments or broken into smaller pieces, often using laser energy.

Unlike procedures that require an incision through the skin, ureteroscopy reaches the urinary tract through the existing urinary passage.

The exact technique depends on:

• Stone size

• Stone location

• Number of stones

• Stone composition or density

• Urinary anatomy

• Presence of obstruction

• Infection status

• Kidney function

• Previous stone procedures

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides kidney-function assessment and specialist kidney care for patients with kidney stones and related renal problems. When a stone requires endoscopic removal, appropriate urological coordination may be recommended.

When Is URS Recommended for a Kidney Stone?

Not every kidney stone requires ureteroscopy.

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, causes persistent symptoms, obstructs urine flow or contributes to complications.

URS may be considered when:

• The stone is lodged in the ureter.

• The stone is causing significant or persistent pain.

• The stone is obstructing urine flow.

• The stone has not passed with observation.

• The stone is causing recurrent urinary problems.

• Another treatment is unsuitable or has not provided adequate clearance.

• A kidney stone requires direct endoscopic treatment.

The decision should be based on imaging and the patient's overall clinical condition.

How Does the URS Procedure Work?

Ureteroscopy generally follows several steps.

1. Pre-procedure Assessment

The treating team reviews the patient's medical history, imaging, medicines and laboratory results.

Urine testing may be performed to check for infection before the procedure. If a urinary infection is present, it may need appropriate treatment before definitive stone removal.

2. Anaesthesia

Ureteroscopy is generally performed under anaesthesia so the patient remains comfortable during the procedure.

3. Ureteroscope Insertion

The ureteroscope is introduced through the urethra into the bladder and then guided toward the ureter and, when required, the kidney.

No external incision is generally needed to reach the stone.

4. Stone Identification

The surgeon uses the camera on the ureteroscope to locate the stone and assess its position.

5. Stone Removal or Fragmentation

Depending on the stone, it may be:

• Removed using a small basket

• Broken into smaller fragments

• Fragmented with laser energy

• Treated using a combination of techniques

Ureteroscopy allows the surgeon to directly visualize the stone during treatment.

What Is Laser URS for Kidney Stones?

Laser URS is a form of ureteroscopy in which laser energy is used to fragment a stone.

The ureteroscope is positioned near the stone, and a small laser fibre can break the stone into smaller pieces.

Depending on the stone and surgical plan, fragments may be extracted using a basket or reduced into small particles that can pass through the urinary tract.

Laser treatment is particularly useful when direct visualization and precise fragmentation are required.

However, not every stone needs the same technique. The stone's size, location, density and anatomy influence the procedure selected.

Can URS Remove Kidney Stones Directly From the Kidney?

Yes.

Flexible ureteroscopy can be used to reach stones located within parts of the kidney.

A flexible ureteroscope can travel through the ureter toward the renal collecting system, allowing the surgeon to inspect and treat selected kidney stones.

For larger or complex renal stone burdens, however, another procedure such as percutaneous nephrolithotomy (PCNL) may be more appropriate.

The best treatment cannot be determined from stone size alone.

URS for Ureter Stones

Ureteral stones are among the common reasons for ureteroscopy.

A stone lodged in the ureter may interfere with urine drainage and produce:

• Sudden flank pain

• Pain radiating toward the abdomen or groin

• Blood in urine

• Nausea or vomiting

• Urinary urgency

• Burning during urination

A larger stone may become stuck and obstruct urine flow.

URS allows the treating surgeon to reach the ureter directly and remove or fragment the obstructing stone.

URS for Kidney Stones Compared With Other Procedures

The treatment chosen for a stone depends on its characteristics.

URS

Ureteroscopy reaches the stone through the urinary tract and can remove or fragment it directly.

Shock Wave Lithotripsy

Shock wave lithotripsy uses externally generated shock waves to break a stone into smaller pieces.

PCNL

Percutaneous nephrolithotomy uses a small access tract through the skin into the kidney and is commonly used for larger renal stone burdens.

Observation

Some small, uncomplicated stones can be monitored because they may pass without an intervention.

The choice depends on the individual patient's imaging, symptoms, stone characteristics and medical condition.

What Tests Are Done Before URS?

Pre-procedure assessment may include:

Imaging

Ultrasound or CT may be used to determine:

• Stone size

• Stone location

• Number of stones

• Degree of obstruction

• Relevant urinary anatomy

Urine Testing

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

Treating a urinary infection before an elective stone procedure is important.

Blood Tests

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

• Serum creatinine

• eGFR

• Electrolytes

• Blood count

• Other tests required for anaesthesia or medical assessment

Kidney-function assessment is particularly important when there is obstruction, previous kidney disease or other medical conditions.

Is a Ureteral Stent Needed After URS?

A ureteral stent is a small flexible tube placed inside the ureter to maintain urine drainage.

A stent may be used after ureteroscopy when the treating surgeon believes temporary drainage or ureteral support is beneficial.

It may be considered when:

• The ureter is swollen after the procedure.

• There is concern about temporary obstruction.

• Stone fragments need to pass.

• The procedure involved significant manipulation.

• The surgeon wants to support urine drainage during healing.

A stent is not necessarily required after every ureteroscopy.

When a temporary stent is placed, the patient should understand the planned removal or exchange schedule. Stents can cause urinary urgency, frequency, discomfort or blood in the urine.

What Does a Stent Feel Like After URS?

Some patients experience temporary:

• Frequent urination

• Urgency

• Burning while urinating

• Bladder discomfort

• Flank discomfort

• Mild blood in urine

These symptoms can occur because the stent irritates the urinary tract.

Severe pain, fever, inability to urinate or significant bleeding requires medical assessment.

How Long Does Recovery After URS Take?

Recovery varies according to the stone, procedure and individual health.

Many patients can return home the same day after uncomplicated ureteroscopy, although some situations may require overnight observation or a longer stay.

After the procedure, mild urinary discomfort or small amounts of blood in the urine may occur temporarily.

Recovery instructions may include guidance regarding:

• Medicines

• Physical activity

• Fluid intake

• Stent care

• Follow-up appointments

• Imaging

• Stone analysis

The treating team should provide individualized instructions.

What Are the Possible Risks of URS?

Ureteroscopy is widely used for stone treatment, but like any medical procedure, it has potential risks.

Possible complications include:

• Urinary tract infection

• Bleeding

• Pain or urinary discomfort

• Ureteral irritation

• Ureteral injury

• Anaesthesia-related complications

• Residual stone fragments

• Need for another procedure

• Stent-related symptoms

The risk depends on the patient's health, stone characteristics and complexity of the procedure.

Can URS Fail to Remove the Entire Stone?

Yes.

Complete stone clearance cannot be guaranteed in every procedure.

A stone may be difficult to reach because of:

• Large stone burden

• Unfavourable anatomy

• Multiple stones

• High stone density

• Narrow ureter

• Difficult location

• Significant swelling or inflammation

A patient may sometimes require a staged ureteroscopy, another stone-removal procedure or follow-up treatment.

The goal is safe and effective stone clearance while minimizing unnecessary injury.

What Happens If the Stone Is Too Large for URS?

For a large or complex kidney stone, the treating specialist may recommend another procedure.

PCNL is commonly used for larger renal stones because it allows instruments to access the kidney directly through a small tract.

In selected situations, treatment may involve:

• PCNL

• Shock wave lithotripsy

• Flexible ureteroscopy

• Staged procedures

• Combined treatment

The appropriate approach depends on imaging and the patient's clinical condition.

What If a Kidney Stone Is Infected and Blocking Urine?

This situation requires particular caution.

An infected urinary system combined with obstruction can become a serious medical emergency.

The immediate priority may be to establish urine drainage, for example with a ureteral stent or nephrostomy, while appropriate treatment for infection is provided.

Definitive stone removal may be performed after the infection has been appropriately managed.

Patients with a known stone should seek urgent medical attention for:

• Fever or chills

• Severe flank pain

• Very low or absent urine output

• Persistent vomiting

• Confusion

• Rapid deterioration

Does URS Affect Kidney Function?

Ureteroscopy is intended to treat the stone while preserving the urinary tract and kidney function.

In patients whose kidney function is already reduced, treatment planning may require additional attention to:

• Creatinine

• eGFR

• Obstruction

• Infection

• Hydration status

• Medicines

• Overall medical condition

A stone that blocks urine flow can itself threaten kidney function, so the risks and benefits of intervention should be evaluated individually.

What Happens to the Stone After URS?

When stone fragments are retrieved, they may be sent for stone analysis.

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

Depending on the patient's history, the doctor may also recommend metabolic evaluation or urine testing.

Preventive management can include individualized advice regarding:

• Fluid intake

• Sodium intake

• Dietary patterns

• Calcium intake

• Oxalate

• Uric acid

• Prescribed preventive medicines

The goal is not only to remove the current stone but also to reduce the chance of recurrence.

Can Kidney Stones Come Back After URS?

Yes.

URS removes or fragments the existing stone, but it does not necessarily eliminate the metabolic or dietary factors that caused stone formation.

New stones can develop later.

For recurrent stone formers, preventive evaluation may include stone analysis and, when appropriate, 24-hour urine testing to assess urine volume and mineral levels.

How Can You Reduce the Risk of Another Kidney Stone?

Prevention should be individualized.

General measures may include:

• Maintain appropriate fluid intake.

• Avoid excessive dietary sodium.

• Follow the diet recommended for your stone type.

• Take prescribed preventive medicines correctly.

• Complete recommended metabolic testing.

• Attend follow-up imaging when advised.

• Treat recurrent urinary infections appropriately.

People with kidney failure, advanced CKD, heart disease or prescribed fluid restrictions should not increase fluid intake without medical guidance.

Kidney and Stone Care at Prabhakar Bhurke Clinic

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

Depending on the clinical situation, care may include:

• Reviewing ultrasound or CT reports

• Assessing creatinine and eGFR

• Evaluating urinary obstruction

• Assessing infection risk

• Reviewing recurrent stone history

• Managing kidney-function abnormalities

• Evaluating associated medical conditions

• Coordinating with appropriate urological specialists for stone procedures

• Planning kidney follow-up after stone removal

• Supporting long-term stone prevention

For patients requiring URS kidney stone removal, the exact procedure and surgical plan should be determined by the treating urological team after reviewing the stone and the patient's overall health.

Frequently Asked Questions

What is URS kidney stone removal?

URS, or ureteroscopy, is a procedure in which a thin scope is passed through the urinary tract to reach a stone in the ureter or kidney. The stone can then be removed or broken into smaller pieces.

Is laser used during URS?

Yes. Laser energy may be used during ureteroscopy to fragment kidney or ureteral stones into smaller pieces.

Is URS painful?

The procedure itself is performed under anaesthesia, so significant pain is generally controlled during treatment. Temporary discomfort, urinary urgency or burning can occur afterward.

Is a stent always placed after URS?

No. A stent may be placed when temporary drainage or ureteral support is considered necessary. If used, it is generally intended to be temporary according to the treating doctor's plan.

How long does URS kidney stone removal take?

Procedure duration varies according to stone size, location, number of stones and complexity. The treating surgeon can provide a more accurate estimate after reviewing imaging.

Can URS remove a stone from the kidney?

Yes. Flexible ureteroscopy can reach selected stones within the kidney and treat them. Larger or complex stones may be better suited to PCNL or another approach.

Can I go home the same day after URS?

Many uncomplicated ureteroscopies are performed as outpatient procedures, but some patients may need observation or an overnight stay depending on the procedure and medical condition.

What should I do if I develop fever after URS?

Fever after ureteroscopy should be reported promptly to a healthcare professional because infection can be a serious complication. Seek urgent medical care if fever occurs with chills, severe pain, confusion or difficulty passing urine.

Conclusion

URS kidney stone removal is an established minimally invasive approach for treating selected stones in the ureter and kidney. A ureteroscope allows the treating surgeon to directly visualize the urinary tract and remove or fragment stones, with laser lithotripsy commonly used for stone fragmentation.

The right treatment depends on the stone's size, location, number, density, urinary anatomy, obstruction, infection status and the patient's overall health. Some stones can be observed, while others may require URS, shock wave lithotripsy, PCNL or a staged treatment approach.

A temporary ureteral stent may sometimes be required after URS, and follow-up is important to confirm stone clearance and address recurrence risk.

If you have been diagnosed with a kidney or ureteral stone, specialist assessment can help determine whether URS kidney stone removal or another treatment is appropriate.

For kidney-function assessment and individualized kidney care, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

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. URS kidney stone removal is a medical procedure and the appropriate treatment depends on stone size, location, number, composition, urinary anatomy, infection status, kidney function and overall health. URS is generally performed by a qualified urological specialist, while a nephrologist may be involved when kidney-function problems or associated medical conditions require specialist management. Do not take painkillers, antibiotics or stone medicines without appropriate medical advice. Fever, chills, severe pain, inability to urinate, very little urine, heavy bleeding, confusion or rapidly worsening symptoms after a stone or procedure require urgent medical attention. Consult Dr. Sandip Prabhakar Bhurke or an appropriate qualified specialist for individualized care.