URSL Surgery for Ureteric Stone: Procedure, DJ Stent and Recovery
URSL surgery for ureteric stone is a minimally invasive procedure used to remove or break a stone stuck in the ureter — the urine tube between the kidney and bladder. It is usually done through the natural urine passage, without a cut on the body. During URSL, a thin telescope is passed up to the stone, and the stone is broken with laser or another energy source. URSL may be advised when the stone is unlikely to pass, pain keeps returning, urine flow is blocked, kidney swelling is present, or kidney function is at risk.
What is URSL surgery for ureteric stone?
URSL means ureteroscopic lithotripsy. It is also called ureteroscopy for ureter stone.
In simple words, it is a keyhole-type endoscopic surgery done from inside the urinary passage. A urologist passes a small telescope through the urethra into the bladder and then into the ureter. Once the stone is seen, it can be broken into small pieces or removed with tiny instruments.
BAUS lists ureteroscopy for stones as a stone procedure and describes patient leaflets for urological procedures, including ureteroscopy and ureteric stent insertion.
When is URSL needed?
Not every ureteric stone needs surgery. Some small stones pass with medicines, fluids and observation. But waiting is not safe for everyone.
URSL may be advised if you have:
- A stone that is unlikely to pass naturally.
- Persistent pain despite proper pain medicines.
- Repeated emergency visits for renal colic.
- Hydronephrosis, meaning kidney swelling due to blockage.
- Reduced kidney function.
- A single functioning kidney.
- Stone with ongoing blockage.
- Failed medical expulsive therapy.
- A job, travel plan or personal situation where faster clearance is important.
EAU guidelines list indications for ureteric stone removal as low chance of spontaneous passage, persistent pain despite analgesics, persistent obstruction and renal insufficiency such as renal failure, bilateral obstruction or a single kidney.
When can medicines be tried first?
Medicines and observation may be reasonable when:
- The stone is small.
- Pain is controlled.
- There is no fever or urine infection.
- Kidney function is normal.
- Hydronephrosis is absent or mild.
- The patient can return quickly if symptoms worsen.
Medical expulsive therapy may help selected patients, especially for distal ureteric stones more than 5 mm, but it should not be continued if complications develop. EAU guidance states that conservative treatment should be stopped if infection, refractory pain or deterioration of kidney function occurs.
When is URSL urgent?
URSL itself is not always done urgently. The urgent decision is usually whether the kidney needs drainage.
If a stone blocks the ureter and the patient has fever, chills, pus in urine, sepsis, rising creatinine, no urine output or a single kidney, this can become dangerous. In such cases, the first step may be urgent DJ stenting or nephrostomy, followed by definitive stone surgery later.
EAU guidelines state that an obstructed kidney with signs of urinary tract infection or anuria is a urological emergency, and urgent decompression may be needed to prevent further complications.
What can happen if a ureteric stone is delayed too long?
A blocked ureter is not just a pain problem. Long-standing obstruction can cause:
- Repeated severe pain.
- Kidney swelling.
- Urine infection.
- Fever or sepsis.
- Reduced kidney function.
- Emergency admission.
- Need for temporary drainage before final stone surgery.
Many patients wait because pain reduces after injections. But pain relief does not always mean the stone has passed. Follow-up imaging is important if a stone was seen on USG or CT.
URSL vs ESWL vs RIRS: Which is better?
| Option | What it means | Usually useful for | Main limitation |
|---|---|---|---|
| Medicines/observation | Waiting for the stone to pass with medicines | Small stones, stable patient, no infection | Stone may not pass |
| ESWL | Shock waves from outside the body break the stone | Selected ureter/kidney stones | May need repeat sessions |
| URSL | Telescope through urine passage to treat ureter stone directly | Stone stuck in ureter, especially mid/lower ureter | Anaesthesia and possible DJ stent |
| RIRS | Flexible telescope into kidney with laser | Kidney stones or upper ureter stones near kidney | More equipment-dependent |
EAU guidance says URS gives a better chance of becoming stone-free with a single procedure, while shock wave lithotripsy has lower morbidity but may need more retreatment or secondary procedures.
How is URSL surgery done?
URSL is usually done in an operation theatre under spinal or general anaesthesia.
The usual steps are:
- You are positioned for endoscopic urinary surgery.
- A small camera is passed through the urine passage into the bladder.
- The opening of the ureter is identified.
- A safety guidewire is passed into the ureter.
- A ureteroscope is gently advanced up to the stone.
- The stone is broken with laser or pneumatic energy.
- Fragments may be removed with a basket.
- A DJ stent may be placed if needed.
There is usually no external cut. If the ureter is too tight, swollen or unsafe to enter, the surgeon may place a DJ stent first and plan URSL after a few days or weeks.
Preparation before URSL
Before planned URSL, your urologist may advise:
- CT KUB or ultrasound KUB.
- Urine routine.
- Urine culture.
- Serum creatinine.
- CBC and blood sugar.
- Fitness tests if needed.
- Review of blood thinners.
- Anaesthesia fitness.
Urine infection should be treated before planned stone surgery. EAU guidelines recommend urine culture or microscopy before stone treatment and treating urinary tract infection before stone removal.
Tell your doctor if you have fever, diabetes, heart disease, kidney disease, pregnancy, previous ureter surgery, drug allergy or blood thinner use.
Anaesthesia and hospital stay
URSL may be done under spinal anaesthesia or general anaesthesia. The choice depends on stone location, patient fitness, expected surgery time and anaesthetist assessment.
Many uncomplicated patients go home the same day or next day. Hospital stay may be longer if there was fever, pus, kidney function concern, difficult stone, bleeding risk or need for observation.
Before discharge, ask clearly:
- Was the stone fully cleared?
- Was a DJ stent placed?
- When should the stent be removed?
- Which medicines are needed?
- What symptoms are normal?
- What symptoms are dangerous?
- When is follow-up imaging needed?
DJ stent after URSL: Why is it placed?
A DJ stent is a soft temporary tube placed inside the ureter. One end stays in the kidney and the other end stays in the bladder. It keeps urine flowing while swelling settles.
A stent may be placed after URSL if:
- The stone was impacted.
- The ureter was swollen.
- There was minor ureter injury.
- Fragments may still pass.
- Infection risk was present.
- The procedure was difficult.
- A second procedure may be needed.
DJ stent symptoms: What is normal?
Common DJ stent symptoms include:
- Frequent urination.
- Sudden urgency.
- Burning while passing urine.
- Mild blood in urine.
- Lower abdominal discomfort.
- Flank pain while passing urine.
- Pain after walking, travel or activity.
These symptoms can be irritating but are often temporary. They usually improve after stent removal.
However, a DJ stent should not be forgotten. If it stays inside too long, it can develop stone deposits, infection and become difficult to remove.
Benefits of URSL
URSL has several advantages:
- Direct treatment of the stone.
- Usually no cut on the body.
- Good option for stones stuck in the ureter.
- Faster relief from blockage.
- Short hospital stay in many patients.
- Stone fragments may be sent for analysis.
- Useful when ESWL is not suitable or has failed.
- Can be planned based on CT findings.
The final success depends on stone size, stone location, stone hardness, ureter swelling, infection, anatomy and available equipment.
Risks and possible complications
URSL is commonly performed, but no surgery is risk-free.
Possible risks include:
- Burning urination.
- Blood in urine.
- Pain due to DJ stent.
- Fever or urine infection.
- Residual stone fragments.
- Stone migration into the kidney.
- Need for second procedure.
- Ureteric injury or perforation.
- Ureteric narrowing later, called stricture.
- Anaesthesia-related risks.
EAU notes that ureteroscopy has fewer retreatments and secondary procedures compared with SWL, but it may have higher complication rates and longer hospital stay than SWL.
Recovery after URSL surgery
Recovery is usually quick, but stent symptoms can make the first few days uncomfortable.
First 24–48 hours
You may notice burning urine, pink urine, frequent urination, mild flank pain or bladder discomfort. Drink fluids as advised by your doctor, unless you have been asked to restrict fluids.
First week
Most patients can walk and do light routine activity. Avoid heavy lifting, intense exercise, dehydration, long bike rides and unnecessary travel if stent symptoms are severe.
After DJ stent removal
Many patients feel much better within 24–72 hours after stent removal. Mild burning or blood in urine may happen briefly. Fever, severe pain or inability to pass urine is not expected.
Return to work, travel, exercise and sex
Desk work may be possible within a few days if pain and urinary symptoms are controlled. Heavy physical work may need more time. Travel is better after discussing stent status with your urologist. Sex can usually resume once pain, bleeding and urinary discomfort settle.
Red flags after URSL
Seek urgent medical care if you have:
- Fever, chills or shivering.
- Severe flank pain not relieved by medicines.
- Inability to pass urine.
- Increasing blood in urine with clots.
- Repeated vomiting.
- Burning urine with fever.
- Dizziness, weakness or very low urine output.
- Severe stent pain.
- Stent thread pulled out accidentally.
- Worsening symptoms after initial improvement.
Follow-up after URSL
Follow-up is important even if pain is gone.
Your urologist may advise:
- DJ stent removal on a planned date.
- Ultrasound KUB.
- X-ray KUB if the stone is visible on X-ray.
- CT KUB in selected cases.
- Urine culture if infection was present.
- Creatinine test if kidney function was affected.
- Stone analysis.
- Stone prevention advice.
Stone surgery removes the current stone. It does not remove the tendency to form future stones. Prevention needs hydration advice, diet changes and sometimes metabolic evaluation.
Consultation checklist: What to bring
Bring these reports to your urology visit:
- USG KUB report.
- CT KUB films and report.
- Urine routine report.
- Urine culture report.
- Serum creatinine.
- CBC and blood sugar reports.
- Current medicines.
- Blood thinner details.
- Fever or admission records.
- Previous stone surgery records.
- DJ stent discharge summary, if already stented.
- Any passed stone fragment.
FAQs about URSL surgery for ureteric stone
Is URSL surgery for ureteric stone painful?
The surgery is done under anaesthesia, so you should not feel the procedure. After surgery, burning urine, frequent urination, mild flank pain or DJ stent discomfort can occur.
Is URSL a laser surgery?
URSL is the endoscopic procedure. Laser is commonly used during URSL to break the stone. Some centres may use pneumatic lithotripsy depending on the stone and available equipment.
Will I always need a DJ stent after URSL?
No. Some uncomplicated cases may not need a stent. A stent is more likely if the stone was impacted, the ureter was swollen, infection risk was present or fragments may pass later.
How long does the DJ stent stay after URSL?
The timing depends on surgery findings. It may stay for a few days to a few weeks. Always follow the exact stent removal date given by your urologist.
Can I travel with a DJ stent?
Many patients can travel with a DJ stent, but long travel may increase pain, urgency or bleeding. Discuss travel plans with your urologist, especially after difficult surgery or infection.
Can a ureteric stone come back after URSL?
Yes. URSL removes the present stone, but new stones can form later. Hydration, diet changes, stone analysis and metabolic evaluation may reduce recurrence risk.
What if URSL fails?
If the ureter is narrow, the stone moves upward, visibility is poor or infection risk is high, the surgeon may place a DJ stent and plan a second procedure such as repeat URSL or RIRS.
Is URSL better than ESWL?
It depends on stone size, location, hardness and patient factors. URSL usually gives faster direct clearance for a stuck ureteric stone. ESWL is less invasive but may need repeat sessions.
Related reading
- Stone Stuck in Ureter: Symptoms and Treatment
- When Does Kidney Stone Need Surgery?
- Laser Treatment for Kidney Stone
- RIRS Surgery for Kidney Stone
- URSL vs RIRS: Which Is Better?
- Kidney Stone Doctor in Latur
References
- European Association of Urology. Guidelines on Urolithiasis https://uroweb.org/guidelines/urolithiasis/chapter/guidelines
- American Urological Association. Surgical Management of Kidney and Ureteral Stones guideline https://www.auanet.org/guidelines-and-quality/guidelines/surgical-management-of-kidney-and-ureteral-stones
- British Association of Urological Surgeons. Stone procedure patient information leaflets https://www.baus.org.uk/patients/information_leaflets/category/10/stone_procedures
- European Association of Urology. Ureteroscopy patient information https://patients.uroweb.org/condition/kidney-stones/larger-kidney-stones/ureteroscopy-urs