Ureterorenoscopy with lithotripsy (URS)

What is it?

According to the latest studies, URS is the technique that is most widely used for the treatment of urinary stones, accounting for more than 60% of surgical procedures performed.

Technical difficulty:
Average duration of the intervention:
60 minutes
Average duration of hospitalization:
2 days

When is this procedure indicated?

According to the European Association of Urology (EAU) guidelines, urethenorenoscopy with lithotripsy (URS) should be considered as the first choice option for cases of ureteral stones in which spontaneous stone expulsion has not occurred. In particular, it is the gold standard for ureteral calculi above 10mm in size regardless of the localization of the stone, while in stones smaller than 10mm uretenorenoscopy can be used in a manner comparable to shock wave lithotripsy (ESWL). It is also recommended as the first choice treatment for kidney stones up to 2 cm that merit surgical treatment.

Cases in which active ureteral stone removal is indicated are:

  • Calculi that are unlikely to be expelled spontaneously;
  • Persistent colic pain despite adequate drug therapy;
  • Renal obstruction;
  • Renal insufficiency.

While cases where active removal of kidney stones is indicated are:

  • Calculus increased in size;
  • Obstruction;
  • Infection;
  • Symptomatic patient;
  • Calculi >15mm.

How is it performed?

Ureterorenoscopy (URS) is an endoscopic procedure (which therefore does not involve skin incisions) that uses a special endoscopic instrument, the ureterorenoscope.

This instrument, passing through the external urethral meatus, the urethra and the bladder reaches the ureter and the kidney, allowing to visualize these structures and to identify the presence of both suspicious lesions in the heteroformative sense (tumors of the upper excretory tract) and stones.

Once the stone has been identified, it can be crushed using a Holmium laser (Holmium laser lithotripsy) or with the aid of shock waves (Lithoclast). At the end of the procedure, a ureteral catheter (double J type) is usually placed to ensure proper outflow of urine along the ureter. This catheter is then removed on an outpatient basis after a period of time that varies depending on the case and is usually between 10-30 days.


Usually the average hospital stay after ureterorenoscopy with lithotripsy is 1-2 days, with an immediate return to working life. While the ureteral stent is in place, the patient may experience increased frequency of urination, urgency of urination, burning sensation at urination, and/or blood in the urine. These complaints usually disappear immediately after the stent is removed.

Short-term complications

According to the European Association of Urology (EAU), the complication rate after ureterorenoscopy is between 9 and 25 percent of case series. These are usually minor complications related to infectious issues, for which antibiotic therapy and prolonged hospitalization may be needed. More rare events are related to the occurrence of renal hematomas or ureteral injuries due to the passage of endoscopic instruments.

Long-term complications

A long-term complication may be the onset of ureteral stenosis related to the trauma of endoscopic instrumentation during surgery. The presence of clinically significant residual lithiasic fragments after initial treatment may be considered a long-term complication and requires additional treatment in order to render the patient stone-free and avoid future patient problems.

Are you interested in receiving the treatment?

Contact us and we will take care of you.