Ureteric Stone Surgery in Jaipur

What a ureteric stone is and how it forms

A ureteric stone is a hard mass that forms in the kidney and moves down into the ureter, the narrow tube that carries urine from the kidney to the bladder. Stones develop when substances in the urine such as calcium, oxalate or uric acid become concentrated and crystallise.

Most stones start small in the kidney and may pass on their own, but once a stone enters the ureter it can block the flow of urine and cause severe pain. Ureteroscopy with laser fragmentation is a common way to treat these stones.

A thin instrument called a ureteroscope is passed through the urethra and bladder up to the stone, and a laser breaks the stone into dust or small pieces that can be removed or passed naturally.

Symptoms of a ureteric stone and when to seek urgent care

The most common symptom is sudden, severe pain in the side or back, below the ribs, that may radiate to the lower abdomen and groin. The pain often comes in waves and can be accompanied by nausea and vomiting. You may notice blood in the urine, a frequent urge to pass urine, or a burning sensation while passing urine.

If you develop fever and chills along with these symptoms, it may indicate an infection in the urinary tract, which needs urgent medical attention the same day. Inability to pass urine despite the urge is another warning sign that requires immediate care.

After the procedure, discomfort and blood in the urine may occur for a few days, especially if a stent is in place, and pain or nausea may occur as remaining stone fragments pass.

Causes and factors that increase the risk of ureteric stones

Stones form when the urine contains more crystal-forming substances than the fluid in the urine can dilute. Low fluid intake, a diet high in salt or animal protein, obesity, and certain medical conditions such as diabetes or gout can raise the risk. A family history of stones also makes them more likely.

In studies, older age, diabetes mellitus, ischaemic heart disease, high body mass index, female gender, neurogenic bladder, and a positive urine culture before the procedure have been associated with a higher risk of infection after ureteroscopy. Preoperative stent placement and longer procedure time have also been linked to increased infection risk.

How a ureteric stone is diagnosed: examination and tests

Your doctor will ask about your symptoms and medical history and examine your abdomen and flank.

A urine test checks for:

• Blood
• Infection
• Crystals

Blood tests assess kidney function and look for high levels of calcium or uric acid. Imaging confirms the stone's size and location. An ultrasound of the abdomen is often the first imaging test. A non-contrast CT scan of the kidneys, ureters and bladder gives the most detailed picture and is the standard for planning treatment.

X-rays may be used in some cases. MRI is rarely needed. These tests help your surgeon decide whether the stone is likely to pass on its own or needs intervention.

Non-surgical treatment options and when surgery is advised

Small stones, usually under 5 millimetres, often pass on their own with plenty of fluids and pain relief. Your doctor may prescribe medicines such as alpha-blockers to relax the ureter and help the stone pass.

If the stone is larger than about 5 to 10 millimetres, causing persistent pain, blocking urine flow, or associated with infection, surgery is usually advised.:

• Persistent pain
• Blocking urine flow
• Associated with infection

Ureteroscopy with laser lithotripsy is commonly used for stones between 5 and 20 millimetres in the ureter. For stones near the kidney, a flexible ureteroscope gives better access. If the ureter is too narrow for the scope, a stent may be placed first to dilate the ureter and the procedure is rescheduled after two to three weeks.

In some cases, a stent alone is placed for temporary drainage if the stone cannot be reached or if there is sepsis.

Preparing for ureteric stone surgery

Before ureteric stone surgery, your surgical team will ask for a few routine tests. These usually include a blood test, a urine test to check for infection, and imaging such as an X-ray or ultrasound to confirm the stone position and size.

If you have a urinary tract infection, it will be treated with antibiotics before the operation because a pre-operative infection raises the risk of urosepsis after the procedure.

Tell your surgeon about every medicine you take, especially blood thinners, diabetes tablets or insulin, and any antibiotics you have used recently. The anaesthesia team will review your health and decide whether spinal or general anaesthesia is safer for you. You will be asked to stop eating and drinking for at least six hours before the scheduled time.

On the day of surgery, bring your test reports, insurance or scheme cards (RGHS, MAA Yojana, CGHS, or private TPA details), a list of current medicines, and comfortable clothes to wear home. An attendant should come with you to help after discharge.

Jaipur Hospital has a 24×7 emergency department, in-house pharmacy, and diagnostic laboratory on site if any last-minute tests are needed.

How ureteric stone surgery is done

Ureteric stone surgery at Jaipur Hospital is performed by our urology team using a ureteroscope — a thin tube with a light and camera — passed through the urethra and bladder up to the stone in the ureter or kidney. The procedure is done under spinal or general anaesthesia and usually takes 45 to 90 minutes.

Your surgeon will choose the technique based on the stone's location, size, and hardness:

• Location
• Size
• Hardness

• Semirigid ureteroscopy with Holmium laser: standard for stones in the lower and middle ureter.
• Flexible ureteroscopy for upper ureter: better access for stones near the pelvi-ureteric junction.
• DJ stenting alone: temporary drainage if the stone cannot be reached safely or if there is sepsis.
• Laser dusting versus basketing: dusting breaks the stone into fine particles that pass with urine; basketing removes larger fragments with a tiny basket.

During the operation, the laser fibre breaks the stone into pieces or dust. The fragments are either removed with a basket or flushed out. A temporary plastic stent (DJ stent) is placed in the ureter in most cases to keep it open while swelling settles and fragments pass. The stent is completely inside the body; no external bag is needed.

If the ureter is too narrow for the scope, a stent is placed first to dilate it, and the procedure is rescheduled after two to three weeks.

The operation is minimally invasive with no cuts or scars. Most patients go home the same day or stay one night.

Risks and possible complications of ureteric stone surgery

Ureteric stone surgery is generally safe, but complications can occur. In studies, the overall complication rate was about 10%. Minor complications such as stent discomfort, blood in urine, or mild infection happened in roughly 5% of patients. Major complications such as ureteral injury, significant bleeding, or urosepsis occurred in about 5%.

The most frequently reported issues are ureteral stent discomfort, ureteral wall injury, and stone migration. Infectious complications account for almost half of all post-operative problems. The pooled incidence of urosepsis in studies was 5% (95% confidence interval 2.4–8.2%). Urosepsis is a serious condition that can lead to multi-organ failure and death, though reported rates are low. Most infectious complications are minor.

Certain factors raise the risk of infection:

• Diabetes
• Older age
• Female gender
• High BMI
• Ischaemic heart disease
• Neurogenic bladder
• Positive urine culture before surgery
• Longer operation time
• Stent left in place for a long time before the procedure

To reduce these risks, our team uses antibiotic prophylaxis, treats any infection before surgery, keeps the operation time short, and removes the stent as early as appropriate.

Other risks include failure to remove all stone fragments and needing to keep a stent in place for a longer period. Your surgeon will discuss how these risks apply to you.

Recovery and aftercare after ureteric stone surgery

After the procedure, you will be monitored in the recovery room for one to two hours. The nursing team will explain how to manage any discomfort or pain. Most patients go home the same day after a brief observation period. You can usually return to desk work in three to five days.

While the stent is in place, you may feel discomfort in the flank or bladder, have urgency to pass urine, or see blood in the urine. Pain and nausea can occur as remaining stone fragments pass. These symptoms usually improve after the stent is removed.

The stent is typically taken out a few days to a couple of weeks after surgery. Some stents have a pull-out string taped to the thigh so you or your attendant can remove it at home; otherwise, a short clinic visit is needed.

Drink plenty of water (about two to three litres a day unless your doctor advises otherwise) to help flush fragments. Take any prescribed pain relief or antibiotics exactly as directed. Avoid heavy lifting and strenuous exercise for the first week.

Call Jaipur Hospital or visit the 24×7 emergency department if you develop a fever above 38°C, severe pain not relieved by medicines, heavy bleeding with clots, inability to pass urine, or signs of infection such as chills and vomiting. These could indicate urosepsis or a blocked stent and need prompt attention.

Results of ureteric stone surgery

In studies, ureteric stone surgery using flexible ureteroscopy and laser lithotripsy achieved a mean stone-free rate of about 94%. For stones between 2 and 3 cm, the stone-free rate was 95.7%; for stones larger than 3 cm, it was 84.6%.

In experienced hands, flexible ureteroscopy can successfully treat stones greater than 2 cm with a high stone-free rate and low complication rate. A comparative study found that for renal stones 2–3 cm, flexible ureteroscopy needed fewer second-stage procedures and was just as effective as percutaneous nephrolithotomy.

Stone-free rates vary between studies because of differences in how "stone-free" is defined and what imaging is used for follow-up. The size and position of the stone also affect the result. Your surgeon will advise whether a single procedure is likely to clear your stone or if a second sitting may be needed.

Stone recurrence is possible over time. Drinking enough fluids, dietary changes, and treating any underlying metabolic cause can reduce the chance of new stones forming. Your urologist may suggest a metabolic work-up after the surgery to guide long-term prevention.

Cost and insurance for ureteric stone surgery in Jaipur

The typical price range for ureteric stone surgery (ureteroscopy with laser lithotripsy and stenting) in India is ₹60,000 to ₹1,50,000. The final cost depends on the technique used (semirigid or flexible ureteroscopy), the size and location of the stone, whether a DJ stent is placed, the type of anaesthesia, and the length of hospital stay (daycare or one night). Diagnostic tests such as X-ray, ultrasound, blood tests, and urine analysis are billed separately.

Jaipur Hospital is empanelled under RGHS, MAA Yojana, CGHS, and a panel of private insurers and TPAs. If you are covered under one of these schemes, the hospital's insurance desk will help you with pre-authorisation and cashless admission where applicable. Bring your scheme or insurance card, photo ID, and any referral letters on the day of admission. The hospital has an in-house pharmacy and diagnostic laboratory, so all tests and medicines can be coordinated on site.