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Ureteral Lithiasis: Semirigid Laser Ureteroscopy

Semirigid laser ureteroscopy is currently one of the most effective and safest treatment methods for ureteral stones, offering patients minimally invasive solutions with rapid recovery and high success rates. Modern technology allows for the precise fragmentation of urinary stones, reducing the risk of complications. At Elytis Hospital, procedures are performed by specialized teams using state-of-the-art equipment, ensuring comprehensive monitoring and personalized care for each patient to achieve optimal results and maximum comfort during treatment.

What is semirigid laser ureteroscopy?

Semirigid ureteroscopy is a minimally invasive endourological procedure used to diagnose and treat ureteral conditions, particularly urinary stones. It involves inserting a semirigid ureteroscope—a small-caliber cylindrical instrument with an integrated optical system—through the urethra and bladder into the ureter. The instrument’s controlled rigidity allows for effective access to the distal and middle ureter, providing a direct view of the stones and facilitating therapeutic interventions, such as laser fragmentation. Compared to the flexible ureteroscope, the semi-rigid instrument provides superior maneuverability in the lower portions of the ureter, greater structural strength, and a more spacious working channel for auxiliary instruments.

History and Evolution of Technology

The first endoscopic procedures performed on the urinary tract appeared in the early 20th century, but the technological limitations of early ureteroscopy—large caliber, poor illumination, and increased risk of trauma—restricted its clinical applicability. The development of optical fibers in the 1970s and 1980s marked a turning point, enabling the introduction of thinner ureteroscopes with superior visibility.

The introduction of modern semirigid ureteroscopy in the late 1980s revolutionized the treatment of ureteral stones, gradually replacing open surgical methods and reducing the need for extracorporeal procedures in difficult cases. The miniaturization of instruments, the advent of advanced irrigation systems, and improvements in ergonomics have significantly contributed to a reduction in complications and an increase in therapeutic efficacy. Over the past two decades, the combination of semi-rigid ureteroscopy and laser technology has become the standard of care in most urological centers.

The Role of Laser Technology in the Treatment of Urinary Stones

Laser technology—particularly the Holmium:YAG laser—is the key factor that has transformed ureteroscopy into an extremely effective and safe procedure. The laser offers significant advantages in the fragmentation of stones:

  • Effective at breaking down any type of calculus, regardless of its composition (calcium oxalate, uric acid, cystine, etc.).
  • Precise energy control, reducing the risk of thermal injury to ureteral tissue.
  • Fine fragmentation (“dusting” or “popcorn technique”), which minimizes the need to remove fragments with forceps or a basket.
  • Operational flexibility, as the thin laser fiber can be easily inserted through the working channel of the ureteroscope.

The integration of laser technology into semirigid ureteroscopy has led to a dramatic increase in treatment success rates (stone-free), a shorter procedure duration, and a reduction in intra- and postoperative complications. Currently, laser ureteroscopy is considered one of the most effective treatment options for ureteral stones and is recommended by all international urological guidelines.

Anatomy and Physiology of the Ureters

The ureters are two muscular tubes, with an average length of 25–30 cm, that carry urine from the kidneys to the bladder. Anatomically, they are divided into three main segments, each with characteristics relevant to ureteroscopy:

  1. The proximal ureter—the portion extending from the pyeloureteral junction to the upper margin of the common iliac artery.
  2. The middle ureter—the segment that passes through the iliac region.
  3. The distal ureter—the portion that extends from the ureterovesical junction to the opening into the bladder.

The ureter naturally has three narrowed anatomical segments where stones frequently become lodged and where maneuvering instruments can be more difficult:

  • The pyeloureteral junction
  • The area where the iliac vessels cross
  • Ureterovesical junction

It is important to be aware of these narrowings in order to avoid iatrogenic trauma during ureteroscopy.

The wall of the ureter consists of three layers:

  • Mucosa: urothelial epithelium, resistant to pressure and friction.
  • Muscle layer: smooth muscle arranged in circular and longitudinal layers, responsible for peristalsis.
  • Adventitia: a vascularized outer layer containing nerve plexuses.

Maintaining the integrity of these structures is essential for preventing strictures or perforations.

Physiology of the Ureters

The ureter functions through peristalsis, a mechanism in which muscle contractions propel urine toward the bladder. During ureteroscopy, peristalsis can affect the position of stones and sometimes hinder the advancement of instruments.

In addition, ureteral irrigation plays a key role in visualization and in reducing trauma to the mucosa. However, the high fluid pressure must be controlled to prevent pyelic reflux and potential infections.

Anatomical Implications in Ureteroscopy

  • The semirigid ureteroscope is ideal for accessing the distal and middle ureter, where the straight anatomy facilitates manipulation.
  • The limited mobility of the distal ureter allows for effective laser application.
  • Anatomical areas where the passage is narrow require special attention to avoid injury.
  • The patient's individual anatomy (pelvic conformation, anatomical variations, presence of strictures) can influence the duration and complexity of the procedure.

 Indications for semirigid laser ureteroscopy

Semirigid laser ureteroscopy is a procedure successfully used in the diagnosis and treatment of ureteral disorders. In modern urological practice, it is one of the first-line methods for treating ureteral stones, particularly in the distal and middle ureter.

Main Indications

Ureteral stones

Ureteral stones are the most common indication. Semirigid ureteroscopy is recommended in the following situations:

  • Distal and mid-ureteric stones, regardless of size.
  • Impacted stones that do not resolve on their own or cause frequent colic.
  • Failure of medical expulsion therapy (MET) after 2–6 weeks.
  • Failure of extracorporeal shock wave lithotripsy (ESWL) or when it is contraindicated.
  • Complex calculations that are difficult to break down using other methods.
  • Acute obstruction of the upper urinary tract, associated with severe pain or hydronephrosis.

Semi-rigid ureteroscopy is particularly effective for distal ureteral stones, where complete treatment rates exceed 90–95%.

Suspected or diagnosed ureteral stricture

  • Direct assessment of the ureteral lumen.
  • Biopsy in cases of suspected neoplasm.
  • Treatment may involve endoscopic resection or dilation.

Small ureteral tumors

In selected cases:

  • Superficial papillary tumors.
  • Small, accessible lesions suitable for biopsy or laser ablation.
    (Note: Only in very specific situations, as indicated by oncology guidelines.)

Foreign Bodies in the Ureter

  • Stent fragments.
  • Postoperative migrated material.
  • Broken instruments.

Guidelines for Specific Contexts

  • Obese patients or those with complex anatomy: ureteroscopy may be preferred over ESWL, which is less effective in patients with a high body mass index or a long pyelocutaneous distance. 
  • Controlled urinary tract infection: This is indicated after stabilization, when obstructive stones are present that contribute to recurrent infections. 
  • Patients with a single functioning kidney: ensures rapid and effective treatment, preventing further deterioration of kidney function. 
  • Pregnancy: Although radiation exposure is avoided, ureteroscopy can be performed safely in specialized centers as an alternative to ESWL (which is contraindicated).

Contraindications

Absolute contraindications include:

  • Severe, untreated urinary tract infection (acute pyelonephritis or uroseptic sepsis).
  • Uncorrected coagulopathies.
  • Patient refusal.

Relative contraindications include:

  • Severe urethral stenosis or a condition that prevents endoscopic access.
  • Major anatomical abnormalities of the urinary tract.
  • Massive hydronephrosis that may require a different management approach.

How is a semirigid laser ureteroscopy performed?

Patient Preparation

Proper patient preparation for semirigid laser ureteroscopy is essential for the success of the procedure, reducing complications, and ensuring a rapid recovery. This includes a comprehensive clinical evaluation, preoperative workup, optimization of the patient’s medical condition, and infection prevention measures.

Preoperative Evaluation

The preoperative evaluation begins with a medical history and physical examination:

  • History of renal colic, episodes of hematuria, urinary tract infections, and previous urological procedures.
  • Risk factors for kidney stones: insufficient fluid intake, hyperparathyroidism, a high-protein diet, and genetic predisposition.
  • Assessment of pain and symptom severity.
  • Examination of the abdomen and lower back for signs of tenderness or infection.

The urologist may also recommend a series of tests to assess kidney function and overall health:

  • Complete blood count – to assess infection or anemia.
  • Serum creatinine and urea – to assess kidney function.
  • Electrolytes – Identifying Imbalances.
  • Coagulation tests—TQ, INR, APTT—especially in patients taking anticoagulants.
  • Urinalysis and urine culture—required. A positive urine culture requires treatment prior to the procedure.

Imaging studies round out the list of tests required prior to surgery:

  • Renal and bladder ultrasound—assessment of hydronephrosis, approximate location of stones.
  • CT scan without contrast (Low-Dose Urography CT) – the gold standard for determining the location, size, and density of stones.
  • Renal-bladder X-ray (optional) – useful for radiopaque stones.

Specific Preoperative Preparation

Specific preoperative preparation begins with prophylactic antibiotic therapy administered in accordance with international urological guidelines, consisting of a single dose of a broad-spectrum antibiotic given 30–60 minutes before the procedure. 

Semirigid laser ureteroscopy is most commonly performed under spinal or general anesthesia. The choice of method depends on the estimated duration of the procedure, the patient’s preference, and any comorbidities. 

The patient should be informed about the goals of the procedure, possible complications, the potential need for a postoperative ureteral stent, the recovery process, and treatment alternatives (ESWL, flexible ureteroscopy, conservative management).

In addition, the following preoperative measures apply:

  • Fasting period in accordance with protocols (usually 6 hours for solids, 2 hours for clear liquids).
  • Thrombosis prevention in high-risk patients (compression stockings, low-molecular-weight heparin).
  • Confirmation of informed consent.

Surgical Technique

The technique of semirigid laser ureteroscopy consists of a well-coordinated series of endourological maneuvers designed to ensure safe access to the ureter, optimal visualization of the stone, and its fragmentation using laser energy. The procedure requires experience, appropriate equipment, and strict adherence to the principles of atraumatic manipulation of the urinary tract.

The patient is placed in the lithotomy position, with the lower limbs slightly flexed, the thighs supported by special pads, and the perineal region fully exposed. Rigorous aseptic technique is performed on the urogenital region, sterile drapes are applied, and the patient is connected to monitoring devices (pulse, blood pressure, oxygen saturation).

Technical Steps of the Procedure

The procedure begins with the insertion of a cystoscope to visualize the ureteral orifices, evaluate the bladder, and, if necessary, aspirate urine for culture. 

A ureteral guide is inserted atraumatically through the ureteral orifice into the ureter.

The ureteroscope is inserted over the guide wire, taking care to respect the natural anatomy, avoiding forcing the instrument, and maintaining visibility through continuous irrigation. The procedure is usually advanced until the stone is visualized.

Once located, the calculation may result in various scenarios:

  • mobile computing, which is easily accessible,
  • A impacted calculus adhering to the mucosa, which requires more delicate handling.

In the case of impacted stones, it is essential to avoid applying excessive force to the instruments in order to prevent perforations.

Holmium:YAG laser fragmentation is the current standard of care. The laser can pulverize the stone into fine particles that can be passed naturally, or it can perform conventional fragmentation, with the resulting fragments being removed during the procedure. 

The holmium laser offers several important advantages:

  • fragmentation of any type of computation,
  • minimal risk of migration,
  • mild thermal effect, gentle on the mucous membrane.

The laser fiber is directed directly at the target, a few millimeters away, avoiding contact with the ureteral tissue.

At the end of the procedure, the integrity of the mucosa is verified, and it is confirmed that there are no perforations and that all significant fragments have been completely removed.

Placement of a Ureteral Stent (JJ)

The need for a ureteral stent (JJ) is determined on a case-by-case basis based on:

  • ureteral trauma,
  • significant edema,
  • pre-existing infection,
  • large stones treated,
  • lengthy procedures.

The stent is usually left in place for 7–14 days.

At the end of the procedure, the ureteroscope is slowly withdrawn, the guidewire is removed, and the patient is transferred to the recovery room.

Postoperative Management

Postoperative management following semirigid laser ureteroscopy has three main objectives: monitoring and immediately treating potential complications, ensuring adequate ureteral drainage, and determining when the patient can be considered fully treated and able to resume normal activities. The following recommendations are general guidelines and should be adapted to local protocols and the specific needs of each patient.

The Immediate Postoperative Period

  • Vital sign monitoring: blood pressure, pulse, oxygen saturation, urine output.
  • Pain assessment — administer analgesics as needed.
  • Monitoring for bleeding (hematuria) — mild hematuria is common and usually temporary.
  • Monitor for signs of infection or sepsis: fever, chills, tachycardia, hypotension. Any suspicion of a severe infection requires blood culture, urine culture, a complete blood count, and empirical IV antibiotic therapy, with hospitalization.
  • If a JJ stent has been inserted: provide instructions regarding the sensation of a foreign body, urinary urgency, and suprapubic discomfort; slight bleeding during urination is possible.

Hospitalization and Discharge

  • Length of hospital stay: Many procedures are performed on an outpatient basis if the patient’s clinical condition is stable, there are no complications, and pain is well controlled. Patients with infection, significant hematuria, uncontrollable pain, or intraoperative complications may require a hospital stay of 24–72 hours.
  • Criteria for discharge: hemodynamic stability, pain control with oral analgesics, tolerance of oral intake, and a patient who is informed and able to contact the team.
  • Medication upon discharge: oral analgesics (acetaminophen ± NSAIDs), an oral antibiotic only if indicated (stent in place, positive urine culture, prophylaxis according to local protocol); antiemetics as needed.

Management of the Ureteral Stent

  • Typical duration of action: usually 7–14 days, sometimes shorter (48–72 hours) or longer (up to 4–6 weeks), depending on the indication.
  • Common symptoms: bladder irritation, frequent urination, hematuria, lower back pain. Symptomatic management includes analgesics, alpha-blockers, and hydration.
  • Removal: on an outpatient basis, via cystoscopy or by pulling on the external thread attached to the stent (if an external thread was left in place); the patient must be informed of the procedure in advance.
  • Follow-up: If the stent is left in place for more than 6 weeks, the risk of encrustation increases—schedule removal.

Postoperative Imaging Monitoring and Outcome Assessment

Postoperative imaging is performed to confirm the absence of significant fragments (“stone-free” status) and to detect complications (residual hydronephrosis, hematoma, etc.).

Tests that your doctor may recommend include:

  • Renal ultrasound + kidney-bladder-ureter (KUB) X-ray at 2–4 weeks for radiopaque stones or at 4–6 weeks for a general evaluation.
  • A low-dose non-contrast CT scan is the most sensitive test for confirming that the patient is stone-free; it is usually performed 4–12 weeks after treatment, depending on the size and composition of the treated stones and the need for accurate confirmation.

If, during the postoperative period, the patient experiences severe pain, fever, or a decrease in urine output, imaging (ultrasound) should be repeated immediately, and the patient should be readmitted if necessary.

Postoperative Complications and Their Management

Like any medical procedure, semirigid laser ureteroscopy can lead to a number of complications, which are rare but require prompt treatment:

  • Persistent or significant hematuria: clinical evaluation, complete blood count; if minor, conservative treatment; in cases of heavy bleeding → hospitalization and endoscopic evaluation.
  • Ureteral perforation: may require stent placement or, in severe cases, surgery (reconstruction/nephrostomy).
  • Infection/urosepsis: treatment with IV antibiotics based on culture results, hemodynamic support; prompt admission of the patient to the intensive care unit if necessary.
  • Postoperative strictures: evaluation and, if necessary, endoscopic treatment (dilatation, endoscopic incision) or reconstructive surgery in persistent cases.
  • Upward migration of fragments (retropulsion): may require repeat surgery (flexible ureteroscopy or percutaneous nephrolithotomy).

Rehabilitation and Recommendations for the Patient

  • Physical activity: gradually resume within 24–48 hours; avoid strenuous physical activity for 1–2 weeks, depending on symptoms.
  • Hydration: increase fluid intake (to more than 2–2.5 L/day, adjusted according to clinical conditions) to facilitate the elimination of small fragments.
  • Avoid excessive local heat and hot baths during the first 48–72 hours if hematuria is present.
  • Medication: pain relievers as needed
  • Avoid anticoagulants/antiplatelet agents immediately after surgery, as indicated by the anesthesiologist and surgeon—resume use as directed by the cardiologist or hematologist.

Medium- and Long-Term Follow-Up and Recurrence Prevention

  • Urological evaluation 2–6 weeks after the procedure (depending on the local protocol) for clinical assessment and follow-up imaging.
  • Metabolic evaluation in patients with recurrent kidney stones or a first severe episode: serum tests (calcium, uric acid, electrolytes) and 24-hour urine analysis (volume, calcium, oxalate, citrate, sodium, urea, etc.). This evaluation allows for personalized preventive measures.
  • Dietary counseling: hydration, reducing sodium intake and excess animal protein, and limiting foods high in oxalates if necessary.
  • Education on the signs that require an emergency return to the hospital: fever, severe lower back pain, anuria, or a significant decrease in urine output, and heavy bleeding.

Criteria for reintervention

  • Symptomatic residual fragments or persistent obstruction confirmed by imaging (progressive hydronephrosis).
  • Recurrent infection associated with residual stones.
  • Uncontrolled pain or persistent hematuria.
  • The presence of a mechanical complication (strictly symptomatic).

Efficiency and Results

Semirigid laser ureteroscopy is currently one of the most effective treatment methods for ureteral stones, offering high rates of complete stone clearance (“stone-free”) and a low risk of complications. The effectiveness of the technique depends primarily on the location, size, and composition of the stones, as well as on the operator’s experience and the technology used (laser, HD camera, modern extraction instruments).

Success Rates Based on the Location and Size of the Calculi

The overall success rates are:

  • For distal ureteral stones: 90–98% stone-free rate.
  • For mid-ureteral stones: 85–95%.
  • For proximal calculi: 75–90% (where the flexible technique may sometimes be preferred).

Success is greatest when:

  • calculii au <10 mm,
  • have not been affected for a long time,
  • the patient does not have severe chronic obstruction,
  • A laser with appropriately adjusted energy is used.

Success rate by size:

  • <10 mm: 95%+ rată de succes.
  • 10–15 mm: 85–90%.
  • 15 mm: 70–80%, depending on the location (sometimes requiring two procedures).

Factors that increase efficiency:

  • the use of modern spraying and fragmentation techniques,
  • easy access to the ureter (no strictures),
  • preoperative stenting in patients with narrow ureters,
  • state-of-the-art optical equipment.

Success rate compared to other methods

Extracorporeal Shock Wave Lithotripsy (ESWL)

Advantages of ESWL: noninvasive, no general anesthesia, rapid recovery.
Limitations: unpredictable results, low efficacy for hard, impacted, or distal stones.

For comparison:

  • For distal ureteral stones >8–10 mm, semirigid ureteroscopy outperforms ESWL with a higher success rate: 90–98% vs. 50–70%.
  • For hard stones (calcium oxalate monohydrate, cystine): URS-laser is the standard method.
  • ESWL often requires 2–3 sessions; ureteroscopy resolves the problem in a single procedure.

Flexible Ureteroscopy (URS-F)

The flexible procedure is more useful for kidney stones than for ureteral stones.

Compared to semirigid ureteroscopy:

  • For the distal and middle ureter, the semi-rigid scope provides better access and more robust instruments.
  • For the proximal ureter or stones migrating toward the kidney, the flexible scope is the preferred option.
  • Both use lasers, with similar results when performed by experienced practitioners.

Open / Laparoscopic Surgery

Today, open or laparoscopic surgery is reserved for rare cases:

  • giant stones,
  • severly altered anatomy,
  • repeated failure of minimally invasive techniques.

Recovery from ureteroscopy takes a few days, while open surgery may require 2–4 weeks. Complications are significantly less common with ureteroscopy. The differences in cost, length of hospital stay, and morbidity favor the endoscopic technique.

Relapses and Prevention Strategies

Recurrence of kidney stones

It occurs in approximately 30–50% of patients within the next 5 years, regardless of the treatment used. Recurrence is related to metabolism and lifestyle habits, not to the effectiveness of ureteroscopy itself.

Risk factors for recurrence:

  • insufficient water intake,
  • a diet high in animal protein, salt, and oxalates,
  • obesity and metabolic syndrome,
  • hyperparathyroidism,
  • recurrent urinary tract infections,
  • genetic predisposition.

Key prevention strategies include:

  • Hydration: at least 2–2.5 L of urine per day.
  • Reducing salt and animal protein.
  • Limit foods high in oxalates (spinach, chocolate, nuts).
  • Adequate intake of citrates (lemons, oranges).
  • Moderate calcium intake (not a strict restriction!).
  • Targeted drug therapy
  • Regular follow-up

 Complications of semi-rigid laser ureteroscopy

Complications from the procedure may occur during or after surgery. They are rare, but should be taken into account.

Lesions of the ureteral mucosa

  • The most common, mild, with no major consequences.
  • They occur when the instrument or laser fiber comes into contact with the mucosa.
  • It usually heals on its own, especially if a JJ stent is inserted.

Ureteral perforation

  • It may occur in cases of complex anatomy, impacted stones, or forced maneuvers.
  • Most perforations are small and are treated with stenting over a period of 2–4 weeks.
  • It rarely requires surgery or conversion.

Hemorrhage / extravasation

  • Significant bleeding is rare.
  • Irrigation fluid may leak out through perforations; treatment depends on the severity.

The Rise of Computation

  • The calculus may migrate to the kidney during fragmentation.
  • It sometimes requires flexible ureteroscopy or subsequent percutaneous nephrolithotomy.

Ureteral avulsion (extremely rare)

  • Complicație severă, <1% în centre moderne.
  • It involves the separation of the ureter from its wall—requiring reconstructive surgery.

Lower Back Pain and Renal Colic

  • Very common in the first 24–72 hours.
  • It is caused by a ureteral spasm or residual fragments.

Hematuria

  • Mild to moderate; it occurs in most patients.
  • It usually goes away in a few days.

Urinary tract infection / postoperative fever

  • Increased risk in patients with infected stones, positive urine cultures prior to surgery, or prolonged obstruction.
  • Treatment: antibiotics based on the antibiotic susceptibility test.

Urinary sepsis

  • A rare but serious complication.
  • It requires intensive treatment, urinary drainage, and aggressive antibiotic therapy.
  • Prevention: sterile preoperative urine culture, reduced intrarenal pressure.

Removal of fragments

  • It can cause occasional pain and difficulty urinating.
  • This is a normal occurrence after lithotripsy.

Ureteral spasm and edema

  • Ureteral edema can lead to transient hydronephrosis.
  • For this reason, a JJ stent is often placed at the end of the procedure.

Ureteral strictures

  • They occur in 1–4% of patients, depending on the extent of intraoperative trauma and preexisting inflammation.
  • They may require endoscopic dilation, prolonged stenting, or reconstructive surgery.

Recurrent gallstone disease

  • It is not a direct complication of the procedure, but rather of the underlying disease.
  • Prevention involves metabolic assessment and lifestyle changes.

Discomfort or pain related to the JJ stent

  • Irritative symptoms: frequent urination, urgent urination, hematuria.
  • They disappear after the stent is removed.
  • There are “comfort” stents and adjunctive therapies for symptom relief (alpha-blockers).

Follow-up surgery required

  • In 5–10% of cases, large fragments remain or the stone migrates.
  • Follow-up surgery is usually also minimally invasive.

Advantages and Limitations

Semirigid laser ureteroscopy is one of the most widely used and effective minimally invasive techniques for the treatment of ureteral stones, offering an excellent balance between outcomes, safety, and patient comfort. Like any medical procedure, however, it has both major benefits and certain limitations that must be understood in order to make the best treatment choice.

Advantages

  • High success rate: superior efficacy for distal and mid-ureteral stones—over 90–98% complete stone clearance rate. The laser allows for the fragmentation of even the hardest stones (cystine). 
  • Minimally invasive: requires no incisions or external surgical access. Direct endoscopic access and excellent visualization of the ureter. 
  • Quick recovery: Most patients are discharged the same day or the next day and quickly return to their normal activities (24–72 hours). 
  • It can be used in situations where other techniques are difficult to apply: obese patients, pregnant women (in specialized centers), and cases of variable anatomy. An ideal alternative to ESWL in cases involving impacted or very hard stones. 
  • Direct visual examination: allows for a complete assessment of the ureter. It provides an opportunity to address other issues at the same time: strictures, small ureteral tumors, and foreign bodies.
  • Low risk of major complications: ureteral avulsion and severe perforations are rare in modern centers. Complications are generally mild and treatable. 
  • It can be repeated without any problems: it does not affect the feasibility of other subsequent procedures, which is important in the context of recurrent stone formation.

Limitations

  • .Difficult access to the proximal ureter: the semirigid ureteroscope does not adapt well to the curves of the upper ureter. For proximal or migrating renal stones, flexible ureteroscopy is preferred. 
  • The need for general or spinal anesthesia: unlike ESWL, which does not require anesthesia. This may be a limitation for patients at high anesthetic risk.
  • The possibility of needing a postoperative JJ stent: the stent may cause discomfort, hematuria, and irritative urinary symptoms. It subsequently requires an additional procedure (its removal). 
  • Risk of ureteral strictures: although low (1–4%), this remains a significant complication, especially in cases of impacted stones or technically challenging procedures.
  • Higher initial costs than ESWL: laser equipment, endoscopes, and supplies are expensive. However, the total cost per case may be lower when the high success rate in the first session is taken into account. 
  • Dependence on the operator's experience: results may vary significantly depending on the expertise of the urology team.
  • It does not prevent recurrent kidney stones: it resolves the acute episode but does not treat the underlying metabolic cause. It must be supplemented with a metabolic evaluation and long-term prevention measures.

Frequently Asked Questions from Patients About Semirigid Laser Ureteroscopy

What is semirigid laser ureteroscopy?

It is a minimally invasive procedure that allows the doctor to insert a thin instrument into the ureter to visualize and treat urinary stones. A laser (usually holmium or thulium) is used to break the stone into small pieces or dust.

Is the procedure painful?

No. The procedure is performed under general or spinal anesthesia. The patient feels nothing during the operation. After the procedure, there may be mild discomfort or a burning sensation when urinating, which subsides within a few days.

How long does the procedure take?

The average duration is between 20 and 60 minutes, depending on:

  • the location and size of the calculation,
  • if the stone is impacted,
  • if additional procedures are required (removal of fragments, stent placement, etc.).

Is hospitalization necessary?

In most cases, the patient can go home the same day or the day after the procedure. Prolonged hospitalization is necessary only in complicated cases (infection, severe pain, comorbidities).

Will I need a ureteral stent (JJ)?

In many cases, yes. A stent is implanted to:

  • to keep the ureter open,
  • to prevent obstruction caused by edema,
  • to facilitate the removal of fragments.

The stent is removed after 7–14 days through a brief, noninvasive procedure.

Does a JJ stent cause pain?

May cause:

  • frequent urination,
  • bitterness,
  • lower back pain when urinating,
  • mild hematuria.

These symptoms are normal and temporary. Your doctor may prescribe medication to relieve them.

How long does recovery take?

Most patients are able to resume their normal lives within 24–72 hours. Strenuous activities or heavy lifting are recommended after a few days.

After the procedure, does the stone disappear completely?

In most cases, yes. The success rate is very high. However, small fragments may remain, which are eliminated spontaneously. A second procedure is rarely necessary.

Can complications arise after ureteroscopy?

Complications are rare but possible:

  • hematuria,
  • urinary tract infection,
  • colic,
  • ureteral strictures (rare, long-term).

Most of them are mild and treatable.

When can I go back to work?

It depends on the type of work, but generally:

  • office work: 1–2 days,
  • Intense physical activity: 5–7 days.

Do I need to change my diet after surgery?

Yes, to prevent a relapse. The following is recommended:

  • adequate fluid intake (2–3 L/day),
  • reducing salt and animal protein,
  • limiting foods high in oxalates (spinach, chocolate),
  • consumption of citric fruits (lemons, oranges).

Can I be sexually active after the procedure?

Sexual activity can be resumed after 3–5 days, provided there is no significant discomfort.

What should I do if I have a fever after a ureteroscopy?

A fever may indicate an infection. You should see a doctor or go to the emergency room immediately.

How does it feel when the JJ stent is removed?

Stent removal is a brief procedure (1–2 minutes) that is usually slightly uncomfortable but not painful. In some centers, it is performed without anesthesia; in others, it is performed under local anesthesia.

Is there a risk that the stone will reappear?

Yes. Urinary stones are a recurrent condition; up to 50% of patients may develop new stones within a few years. That is why prevention and metabolic evaluation are essential.

The Benefits of Semirigid Laser Ureteroscopy at Elytis Hospital

Elytis Hospital offers patients access to state-of-the-art technology and medical teams with extensive experience in endoscopic urology. Choosing a specialized center like Elytis offers numerous benefits compared to other medical facilities.

State-of-the-art equipment and technology

  • State-of-the-art semi-rigid ureteroscopes with variable diameters and HD optics, which allow for clear visualization and precise manipulation.
  • High-performance Holmium:YAG and Thulium lasers with adjustable parameters for different types of stones (hardness, size).
  • Modern pressure-controlled irrigation systems that reduce the risk of ureteral trauma and increase patient comfort.
  • Precision surgical instruments, specially designed for atraumatic procedures.

Medical and Multidisciplinary Expertise

  • The urology team consists of specialists with extensive experience in urinary stones and laser ureteroscopy.
  • Collaboration with anesthesiologists and nurses who have experience with minimally invasive endoscopic procedures.
  • Standardized protocol for preparation, intraoperative, and postoperative monitoring to ensure maximum safety.
  • Experience with complex cases: impacted stones, narrow ureters, multiple recurrences, and patients with comorbidities.

Safety and Risk Mitigation

  • Strict adherence to antiseptic protocols and preoperative urine culture significantly reduces the risk of infection.
  • Intensive postoperative monitoring for the early detection of complications.
  • The use of state-of-the-art ureteral stents to reduce discomfort and prevent strictures.

Comfort and the Patient Experience

  • Comprehensive consultation and counseling before and after the procedure.
  • Detailed information on diet, hydration, and preventing the recurrence of kidney stones.
  • Individualized management of postoperative pain and ureteral stent symptoms.

Superior Results and Comprehensive Monitoring

  • High stone-free rate, even for hard or impacted stones.
  • Postoperative imaging and clinical follow-up in accordance with the latest international urological guidelines.
  • Metabolic assessment and personalized recommendations for the prevention of recurrent kidney stones.

Access to innovation and modern techniques

  • The ability to combine the semi-rigid technique with other endoscopic approaches or lithotripsy in complex cases.
  • Adaptability based on the patient's anatomy and the location of the stone.
  • Ongoing implementation of the latest international protocols for the treatment of urinary stones.

Elytis Hospital provides a safe, modern, and comfortable environment for patients, featuring state-of-the-art technology, specialized teams, and highly effective outcomes, which ensures that semi-rigid laser ureteroscopy is performed successfully and with minimal discomfort.

Laser semi-rigid ureteroscopy is now a safe, effective, and minimally invasive procedure for the treatment of ureteral stones, offering patients rapid removal of stones and a reduced risk of complications. Choosing a specialized center, such as Elytis Hospital, ensures access to state-of-the-art technology, medical teams with extensive experience, and comprehensive monitoring before, during, and after the procedure.

To prevent complications and recurrences and to receive the best medical care, it is essential to consult a specialist and schedule a personalized evaluation. Schedule an appointment today at Elytis Hospital and receive high-performance endoscopic treatment for kidney or ureter stones!

Last revised: December 2, 2025

References: 

  • Li, Zhilong, Xiaoyu Tang, Shaojie Wu, Shaoxi Liu, Xiaolong Wang, Ziqi He, Du Wang, Xinghuan Wang, and Sheng Li. “Efficacy and Safety of Semirigid Ureteroscopy Combined with Ho:YAG Laser Lithotripsy for the Treatment of Proximal Ureteral Calculi: A Single-arm Meta-analysis.” European Urology Open Science, vol. X, 2024, https://pubmed.ncbi.nlm.nih.gov/39512869/. 
  • Jiang, Haowen; Zhong Wu; Qiang Ding; Yuanfang Zhang. “Ureteroscopic Treatment of Ureteral Calculi with Holmium: YAG Laser Lithotripsy.” Journal of Endourology, 2007, https://www.bohrium.com/paper-details/a-meta-analysis-and-systematic-review-of-holmium-laser-treatment-of-bladder-stones/811941803447025664-8763?utm_source=chatgpt.com
  • Keeley, F. X., et al. “Treatment of Ureteral Calculi with Semirigid Ureteroscopy: Where Should We Stop?” Journal of Urology, 2009, https://pubmed.ncbi.nlm.nih.gov/20389152/
  • Author(s). “Efficacy and Safety of Ho:YAG Laser Lithotripsy for Ureteroscopic Removal of Proximal and Distal Ureteral Calculi.” PMC Article, 2013, https://pmc.ncbi.nlm.nih.gov/articles/PMC4132277/?utm_source=chatgpt.com
  • Author(s). “The Expanding Role of Ureteroscopy and Laser Lithotripsy in the Treatment of Proximal Ureteral and Intrarenal Stones.” Review Article, 2002, https://pubmed.ncbi.nlm.nih.gov/12072646/