Semirigid ureteroscopy and ureteric stone treatment

Retrograde direct-vision access to the ureter with a semirigid ureteroscope for stone fragmentation or extraction.

core 4 recorded variations 7 complication modules Also: URS · ureteroscopic stone extraction · ureteroscopic laser lithotripsy

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01 Scope and comparison

Typical place in practice

Active treatment of accessible ureteric calculi and selected diagnostic ureteric assessment.

Alternatives and neighbouring procedures

Observation, shock-wave lithotripsy, flexible ureterorenoscopy, antegrade access or selected surgical removal.

02 Recorded variations

Same procedure family, explicit technique branches

These are variations of this canonical operation. Complication modules below identify whether they apply to all branches or only to named approaches.

01 · Retrograde semirigid

Semirigid URS with basket extraction

A suitably sized mobile stone or fragment is retrieved under direct vision.

02 · Retrograde semirigid laser

Semirigid URS with laser lithotripsy

The ureteric stone is fragmented or dusted before controlled extraction or passage.

03 · Limited retrograde emergency

Emergency drainage-first URS

The priority is safe drainage; definitive stone treatment is performed only when the clinical context permits.

04 · Planned repeat retrograde

Staged semirigid URS

Access or stone clearance is deliberately completed over more than one procedure.

03 Orientation sequence

High-level sequence

Coverage outline only; not a step-by-step technical guide.

Confirm side, stone level, infection status and drainage strategy
Gain bladder and ureteric access while preserving a safe route
Advance under vision without force
Fragment or retrieve stone with controlled energy and traction
Inspect for injury and decide on drainage and follow-up imaging

04 Operative notes

Operative notes

Concise operative notes covering the key steps, landmarks and watch points, in the order you encounter them.

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Operative note 10 Core

Ureteroscopy for ureteric stones

What it does: up the ureter with a thin rigid scope over two wires. Dust the stone.

Cystoscopy first. See the trigone and both orifices.
2 wires. The first is the safety wire: up the centre, to the kidney, under screening. It stays until the end.
Cystoscope out. Semirigid scope in with the second (working) wire through its channel. Wire 2 up the ureter through the scope. It only guides the scope.
Hold both wires gently taut. Railroad the scope over wire 2 to the stone. Advance only under vision. See the lumen always. A semirigid scope barely bends: the ureter straightens over it. The iliac crossing is where it catches.
Orifice too tight? Rotate the scope 180 degrees.
Sheaths rarely help in the ureter.
Finger on the water valve. Minimum flow. Hard flow flushes the stone back to the kidney.
Going over the wire shields the stone.
Stone seen: water off, pull the working wire. Keep the safety wire. Laser or pneumatic in.
Laser tip well clear of the scope lens. Fire against the lens = cracked lens.
Laser: dust it, do not chunk it. Paint the stone. Never leave large pieces in the ureter: they scatter and they do not pass. Dust clouds: wash out, refire.
Let dust and fine fragments clear by gravity. A piece too big to clear: basket it, test the pull first. Resists? Release, laser it smaller. Never drag. Scope and basket come out together, fragment at the tip, wall inspected all the way down. One fragment out is not stone-free: the dust stays to pass.
Stent after if: hole in the ureter, torn mucosa, leftover fragments, dilated stricture, 1 kidney, both sides done, or case over ~45 min.
Simple low stone? No routine stent. (CROES data.)

2026 update: No change. This is still current practice.

Watch: Scope sizes: tip 6 to 8 Fr, shaft 7.5 to 10 Fr, channel 3.6 Fr (or 2.4 and 3.4 Fr), wires 0.035 or 0.038 inch, fibre 200 to 365 micron. Owner-confirmed typical sizes.

Wire will not pass a stone: Catheter up to just below the stone: its support often lets the sensor wire through. No? A little contrast: is the stone blocking? None passes? Terumo hydrophilic wire. Terumo up: follow with the catheter, exchange to a sensor wire. Stenting over a Terumo is hard. Still stuck: call the consultant. Semirigid scope fragments the stone so the wire passes.

JJ over the wire: Four thin black dashes, then the thick band. Band going into the orifice: scope back to the bladder neck. Push till the golden pusher tip shows. Stop. Wire out completely. Curl in the kidney on the screen. In the bladder the stent's own end drops and curls on the base: one open coil in line with the shaft, not a separate loop out of the orifice. Lateral orifice: right side arrow to 3 o'clock, wire angles to 9; left side arrow to 9, wire to 3.

Catheter will not go up the orifice: Guidewire through the ureteric catheter, soft tip just beyond the end. Lead the tip into the orifice. The catheter follows over it. Contrast on the screen only: it is not seen through the scope.

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05 Procedure-specific complications