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Asian Healthcare Specialist
Asian Healthcare Specialist

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+65‎ 6334‎ 1486
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Ureteroscopy and Laser Lithotripsy (URS) in Singapore

Kidney or ureteral stones can cause pain and affect daily activities. Stone passage may require medical attention and can impact quality of life. Ureteroscopy and laser lithotripsy (URS) is a minimally invasive procedure for removing stones from the urinary system, performed without external incisions. This established endoscopic procedure aims to help patients manage urinary stones.

*Individual results and timelines may vary.*

Dr. Nor Azhari Bin Mohd Zam
Dr. Nor Azhari Bin Mohd Zam

MBBS (NUS)|MRCS (Edin.)|MMed Surgery (NUS)|FAMS (Urology)

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Screenshot Ureteroscopy and Laser Lithotripsy (URS)
Suitability Techniques Process Recovery Benefits Risks Cost FAQ Conclusion
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Suitability
Techniques
Process
Recovery
Benefits
Risks
Cost
FAQ
Conclusion

What is Ureteroscopy and Laser Lithotripsy?

Ureteroscopy and laser lithotripsy is a highly effective, minimally invasive procedure for kidney stone removal in Singapore, used specifically to diagnose and treat stones lodged in the kidneys and ureters (the tubes connecting the kidneys to the bladder). During this procedure, a thin, flexible telescope called a ureteroscope is inserted through the urethra and bladder to reach the stone. Once the stone is located, a laser fibre is passed through the ureteroscope to break the stone into smaller pieces that can be removed or may pass naturally.

This technique combines diagnosis with treatment, allowing your urologist to locate and treat stones in a single procedure. It can be suitable for stones in the ureter and the lower pole of the kidney, as well as stones that haven’t responded to conservative care. URS is a recognised option for urinary stones with reduced recovery time compared with traditional open surgery.

The holmium laser used in lithotripsy delivers energy pulses that can break stones of various types, including calcium oxalate, uric acid, and struvite stones. This versatility, together with the procedure’s minimally invasive nature, makes URS a strong choice for many patients with kidney and ureteric stones. For personalised advice and scheduling, clinics offering ureteroscopy in Singapore can assess suitability and outline the expected recovery.

*Individual results and treatment outcomes may vary.*

Who is a Suitable Candidate?

Potential Candidates

Potential Candidates

  • Patients with ureteral stones causing obstruction or persistent symptoms
  • Individuals with kidney stones in certain size ranges
  • Patients with lower pole kidney stones that may not pass naturally
  • Those who have not responded to medical expulsive therapy for stone passage
  • Individuals with recurrent stone episodes that may require intervention
  • Patients with stones causing recurrent urinary tract infections
  • People who may not be suitable for extracorporeal shock wave lithotripsy (ESWL)
  • Those requiring stone analysis for metabolic evaluation
  • Patients with certain types of stones that may not be suitable for ESWL
  • Individuals considering definitive stone treatment options
Contraindications

Contraindications

  • Active, untreated urinary tract infection
  • Severe bleeding disorders or uncorrected coagulopathy
  • Pregnancy (relative contraindication requiring special considerations)
  • Severe cardiovascular or pulmonary disease preventing general anaesthesia
  • Anatomical abnormalities preventing ureteroscope passage
  • Severe ureteral stricture below the stone location
  • Recently placed ureteral reimplantation

A thorough evaluation by your MOH-accredited urologist is essential to determine if URS may be appropriate for your specific situation. Your medical history, stone characteristics, and anatomical considerations will all factor into the treatment recommendation tailored to your needs.

*Individual suitability and treatment outcomes may vary.*

Treatment Techniques and Approaches

  • Rigid Ureteroscopy

    Rigid ureteroscopy uses a straight, non-flexible scope typically measuring 6-9 French in diameter. This approach may be used for stones in the distal ureter (lower third) where direct access is straightforward. The rigid ureteroscope provides optics and a working channel for stone retrieval instruments. This technique can help with stone fragmentation and extraction for appropriately located stones.

  • Flexible Ureteroscopy

    Flexible ureteroscopy employs a bendable fibreoptic or digital ureteroscope that can navigate the collecting system, including the kidney’s internal anatomy. This technique may treat kidney stones and proximal ureteral stones that cannot be reached with rigid instruments. Modern digital flexible ureteroscopes provide visualisation. The flexible approach allows access to calices of the kidney, making it possible to treat stones in challenging locations such as the lower pole.

  • Laser Types and Settings

    The holmium:YAG laser is commonly used for stone fragmentation during URS. This laser operates at a wavelength of 2,100 nm, which is absorbed by water and stone material. Your urology doctor will precisely adjust the laser settings based on the stone’s specific composition and location, typically using low energy and high frequency for dusting (creating fine fragments) or high energy and low frequency for fragmentation (creating larger pieces for basket extraction). Newer thulium fibre lasers are also becoming available, offering potential advantages in dusting efficiency and reduced retropulsion.

  • Technology & Equipment Used

    Modern ureteroscopy utilises various supporting technologies including digital imaging systems for visualisation, stone retrieval baskets for fragment extraction, and ureteral access sheaths that facilitate repeated scope passage while protecting the ureter. Fluoroscopic guidance helps confirm stone location and aims to ensure stone clearance. Some centres also employ narrow-band imaging technology to distinguish stones from tissue.

Wondering which approach might be suitable for you?

Our MOH-accredited urologist will evaluate your specific needs and discuss the available treatment options.

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The Treatment Process

Pre-Treatment Preparation

Before your URS procedure, you’ll undergo preoperative testing including urine culture to rule out infection, blood tests to assess kidney function and clotting parameters, and imaging studies (CT scan or X-ray) to confirm stone location and size. You’ll need to stop blood-thinning medications as directed by your urologist. Antibiotics may be prescribed if you have a history of urinary infections. You’ll be instructed to fast from midnight before your procedure if general anaesthesia is planned. Arrange for someone to drive you home after the procedure as you won’t be able to drive following anaesthesia.

During the Procedure

Upon arrival, you’ll change into a hospital gown and have an intravenous line placed for medications and fluids. The procedure is performed under general anaesthesia or spinal anaesthesia. Once anaesthesia takes effect, you’ll be positioned in the lithotomy position. Your urologist will first perform cystoscopy to examine the bladder, then advance the ureteroscope towards the stone location.

Using fluoroscopic or direct visual guidance, the stone is identified and the laser fibre is positioned near the stone. The laser is activated in short pulses to fragment the stone whilst irrigation fluid keeps the view clear and cools the tissue. Larger fragments may be retrieved using stone baskets or graspers, whilst smaller pieces are left to pass naturally. The procedure duration varies depending on stone size, location, and number.

Immediate Post-Treatment

After the procedure, you’ll recover in the post-anaesthesia care unit where nurses monitor your vital signs and pain levels. Patients may experience mild to moderate discomfort, which is managed with pain medications. You may notice blood in your urine, which is normal and may resolve within a few days. If a ureteral stent was placed to ensure drainage, you’ll be informed about its management and removal schedule. Patients can typically go home the same day once they’ve urinated successfully and their pain is controlled.

*Individual results and timelines may vary.*

Ureteroscopy and Laser Lithotripsy Recovery and Aftercare

First 24-48 Hours

During the initial recovery period, rest is important but light walking is encouraged to promote stone fragment passage. Drink plenty of water to flush out stone fragments and reduce bleeding. You may experience burning with urination, urinary frequency, and mild bladder spasms, especially if a stent was placed. Pain medication and antispasmodics may help manage these symptoms. Strain your urine through a provided filter to catch stone fragments for analysis. Contact your urologist immediately if you develop fever, severe pain, or inability to urinate.

First Week

Continue increased fluid intake to facilitate fragment passage and maintain clear urine. Patients may return to desk work within a few days, though strenuous activities should be avoided for one week. If you have a stent, you may experience continued urinary symptoms including frequency, urgency, and discomfort with urination. These symptoms are normal but can be bothersome. Your urologist may prescribe medications to help manage stent-related symptoms. Follow-up appointments are typically scheduled to assess stone clearance and plan stent removal if applicable.

Long-term Recovery

Complete stone passage may take several weeks depending on fragment size and location. If a stent was placed, it’s typically removed in a brief office procedure. Follow-up imaging (X-ray or ultrasound) is usually performed to confirm stone clearance. Once cleared, your urologist will discuss stone prevention strategies including dietary modifications, increased fluid intake, and possibly medications based on stone analysis results. Regular monitoring may be recommended for patients with recurrent stones.

Our urologist provides post-procedure support to help with recovery.

Schedule your consultation to learn more about what to expect.

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Benefits of Ureteroscopy and Laser Lithotripsy

Ureteroscopy and laser lithotripsy offers advantages for treating kidney and ureteral stones. The procedure provides stone visualisation and treatment, and may achieve stone-free status in a single session. Unlike shock wave lithotripsy, URS can be effective for various stone types regardless of composition, including cystine and calcium oxalate monohydrate stones that may be resistant to shock waves.

The minimally invasive nature of URS means no external incisions, which may result in less post-operative pain and recovery compared to percutaneous procedures. Patients may return home the same day and may resume normal activities within a week. The procedure allows for stone fragment retrieval, enabling stone analysis to help guide prevention strategies. *Individual results and timelines may vary.*

The precision of laser lithotripsy aims to minimise damage to surrounding tissue while fragmenting stones. This technique may also provide immediate relief from severe urinary obstruction, particularly for patients with infected obstructed systems or those who already suffer from urinary retention requiring prostate enlargement treatment. The ability to treat multiple stones in different locations during the same procedure can add to its efficiency and patient convenience.

*This treatment is administered as part of a comprehensive plan supervised by a healthcare professional.*

Risks and Potential Complications

Common Side Effects

Patients may experience blood in the urine (haematuria) for several days following URS, which typically resolves without intervention. Mild to moderate pain or discomfort is common, particularly if a stent is placed, and is managed with oral pain medications. Urinary symptoms including frequency, urgency, and burning sensation can affect patients but improve as healing progresses. Temporary bladder spasms may occur, especially with stent placement, and can be managed with antispasmodic medications. Small residual stone fragments may cause discomfort as they pass over the following weeks.

Rare Complications

Ureteral injury may occur and can range from minor abrasions to perforation requiring stent placement for healing. Urinary tract infection can develop despite antibiotic prophylaxis and requires prompt treatment. Ureteral stricture (narrowing) is a rare long-term complication. Sepsis, a severe infection response, is very rare but requires immediate medical attention. Stone fragment migration to areas difficult to access may occasionally necessitate additional procedures.

Your MOH-accredited urology specialist in Singapore takes extensive precautions to minimise these risks through careful technique, appropriate antibiotic prophylaxis, and gentle tissue handling. The use of ureteral access sheaths, proper irrigation, and modern flexible ureteroscopes has helped reduce complication rates. Prompt recognition and management of any complications aims to ensure appropriate outcomes for patients.

*Individual results and timelines may vary.*

Cost Considerations for Ureteroscopy and Laser Lithotripsy

The cost of ureteroscopy and laser lithotripsy varies based on several factors including stone size and location, procedure complexity, and whether bilateral treatment is needed. Hospital facility fees, anaesthesia services, and surgeon fees all contribute to the total cost. The type of ureteroscope required (rigid versus flexible) and operative time needed also influence pricing.

Additional costs may include pre-operative investigations such as CT scans and blood tests, ureteral stent placement if required, and post-operative medications. Follow-up consultations and imaging studies to confirm stone clearance should also be considered in your budgeting. The need for stone analysis and metabolic evaluation may incur laboratory fees.

While cost is a consideration, choosing an experienced MOH-accredited urologist aims to provide safe treatment that may help prevent the need for repeat procedures. During your consultation, you’ll receive a detailed cost estimate tailored to your specific treatment requirements.

*Individual results and treatment outcomes may vary.*

Frequently Asked Questions

How long does ureteroscopy and laser lithotripsy take to perform?

The procedure may take 30-90 minutes depending on stone size, number, and location. Kidney stones generally may require more time than ureteral stones due to the need for flexible ureteroscopy and navigation through the collecting system. Multiple stones or bilateral procedures may extend the operative time. You should plan to be at the hospital for several hours total, including pre-operative preparation and recovery time.

*Individual procedure times may vary.*

Will I need a stent after URS, and how long will it stay in?

Ureteral stent placement depends on several factors including pre-operative ureteral dilation, stone burden, and whether any ureteral injury occurred during the procedure. Some patients may receive a stent to help ensure proper drainage and healing. If placed, stents may remain for several days to weeks and are removed in a brief office procedure. Some patients may receive a stent with a string attached for home removal, avoiding the need for a second procedure.

*Individual treatment plans may vary.*

How effective is URS for stone removal?

Ureteroscopy and laser lithotripsy can be effective for stone removal, though outcomes may vary for different stone types and locations. Lower pole kidney stones and larger stones may have different single-session outcomes. Factors that may affect results include stone composition, kidney anatomy, and surgical approach. Follow-up imaging several weeks post-procedure can help assess stone clearance.

*Individual results and outcomes may vary.*

Can kidney stones come back after URS treatment?

URS treats existing stones but doesn’t prevent new stone formation. Stone recurrence may occur in some patients over time without prevention measures. However, with proper dietary modifications, adequate hydration, and sometimes preventive medications based on stone analysis, recurrence risk may be reduced. Regular monitoring and metabolic evaluation can help identify and address risk factors for stone formation.

*Individual risk factors and outcomes may vary.*

What’s the difference between URS and shock wave lithotripsy (ESWL)?

URS is an endoscopic procedure requiring anaesthesia where stones are directly visualised and fragmented internally, while ESWL uses external shock waves without anaesthesia to break stones. URS may have different outcomes compared to ESWL, particularly for lower pole and ureteral stones, and can work on various stone types. ESWL is non-invasive but may require multiple sessions and may be less suitable for certain stone compositions. Your urologist will recommend the most appropriate treatment based on your stone characteristics.

How soon can I return to work after ureteroscopy?

Many patients with desk jobs may return to work within several days after URS. Those with physically demanding occupations should wait longer before resuming heavy lifting or strenuous activities. If you have a stent, you may experience symptoms that could affect your comfort and concentration. Driving can often resume within days after the procedure once you’re off strong pain medications.

*Individual recovery times may vary.*

Are there alternatives to laser lithotripsy during ureteroscopy?

While laser lithotripsy is commonly used for stone fragmentation during URS, alternatives exist for specific situations. Pneumatic lithotripsy uses mechanical energy to fragment stones but may risk fragment migration. Electrohydraulic lithotripsy generates shock waves within the ureter but requires careful technique to avoid tissue injury. Small stones may be retrieved intact using baskets without fragmentation. Your urologist will select the most appropriate technique based on stone characteristics and location.

Conclusion

Ureteroscopy and laser lithotripsy is an effective, minimally invasive treatment option for kidney and ureteral stones that may help provide relief from symptoms. This established procedure combines precise visualisation with targeted stone fragmentation, allowing patients to return home the same day and resume normal activities within a week. For those considering ureteroscopy in Singapore, this approach balances effectiveness with a short recovery. With proper technique and post-operative care, URS offers a safe way to manage stone disease and may help prevent complications.

*Individual results and timelines may vary.*

Ready to Take the Next Step?

If you’re considering ureteroscopy and laser lithotripsy for kidney or ureteral stones, our MOH-accredited urologist can help you understand if it’s the right option for your needs. With experience in endoscopic stone management, we provide personalised care throughout your journey.

Book Your Consultation Today
Dr. Nor Azhari Bin Mohd Zam

Dr. Nor Azhari Bin Mohd Zam

MBBS (NUS)|MRCS (Edin.)|MMed Surgery (NUS)|FAMS (Urology)

Former Director of Endourology (Urinary stone service) Singapore General Hospital 2016 to 2023

With more than 20 years experience as a certified Urologist, Dr Nor Azhari specializes in treating a wide range of kidney, bladder and prostate conditions as well as disorders of the male reproductive organs. He offers minimally invasive treatment options and provides same-day appointments for convenience.

  • Skilled urologist and kidney stone surgeon
  • Recognized with the College of Surgeons Gold Medal and Singapore Urological Association Book prize
  • Minimally invasive treatment options available (non-invasive and endoscopic/key-hole techniques)
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