Prof. Dr. Emel Akoğlu
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- 57+years exp.
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Kidney Stones
Flexible urs with laparoscopic pyelolithotomy
What flexible ureteroscopy combined with laparoscopic pyelolithotomy is, why surgeons use two routes for large or branching kidney stones, how it compares with PCNL and open surgery, what it costs in Turkey against the UK, US and Germany, recovery milestones, the main risks and how to check a hospital.
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Prof. Dr. Zerrin Biçik Bahçebaşı
UrologyVerified
- 37+years exp.
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What is flexible URS with laparoscopic pyelolithotomy?
Flexible URS with laparoscopic pyelolithotomy is a combined, minimally invasive operation for kidney stones that are too large, too many or too awkwardly placed for one technique alone. A pyelolithotomy means opening the renal pelvis, the funnel-shaped part of the kidney where urine collects, and lifting out a stone. Done laparoscopically, the surgeon works through three or four small cuts in the flank or abdomen with a camera. Flexible ureteroscopy (URS) adds a second route: a thin, bendable scope is passed up the urinary tract through the urethra and bladder, with no skin incision, to reach stones in the kidney's calyces that the keyhole instruments cannot easily see or reach.
This guide explains why two routes are sometimes used, how the operation is done, how it compares with other stone treatments, what it costs in Turkey against the UK, US and Germany, and what recovery involves. Other options are described on our kidney stones page and in the wider urology treatments in Turkey section.
Why combine the two techniques?
A single kidney stone in an easy position is usually treated with a laser through a flexible scope or with shock wave lithotripsy. Large stones, stones that fill the renal pelvis and extend into several calyces (staghorn-type stones), and stones in a kidney whose pelvis lies outside the kidney (an extrarenal pelvis) are harder. In these cases the keyhole route removes the main bulk through the pelvis in one piece, while the flexible scope clears the remaining stones in the side calyces, which would otherwise need extra cuts into the kidney tissue. The aim is to leave the kidney stone-free in one anaesthetic with less trauma to the kidney tissue than a larger percutaneous tract would cause. It is a specialist approach, not a routine one, and not every hospital offers it.
How is the combined operation performed?
The operation is done under general anaesthesia and usually takes two to three hours. The order of steps varies by surgeon, but typically:
- A fine ureteric catheter or guidewire is placed through the bladder, often with a ureteral access sheath, to protect the ureter.
- The flexible ureteroscope is passed up to the kidney, and stones in the calyces are fragmented with a holmium laser or moved into the pelvis with a basket.
- The patient is repositioned and three or four ports are placed in the flank or abdomen for the laparoscopic camera and instruments.
- The renal pelvis is opened, the stone removed in a retrieval bag, and the pelvis closed with absorbable sutures.
- A temporary ureteric stent and often a small drain are left in place.
The stone is sent for analysis so that the urologist can advise on preventing new stones.
Does flexible URS with laparoscopic pyelolithotomy work?
For well-chosen large or complex stones, studies reported by urology societies show high stone-free rates with this type of combined approach, and laparoscopic pyelolithotomy has long been used as an alternative to open surgery for large pelvic stones. It is less well-studied than percutaneous nephrolithotomy (PCNL), so the evidence is mostly from single-centre series, and results depend heavily on the surgeon's experience and the stone's shape. No operation can guarantee the kidney is completely clear, and small residual fragments sometimes need a second session or a wait-and-watch approach. Ask the hospital how often it performs the combination, and what stone-free result it aims for, rather than accepting a general promise.
Combined URS and pyelolithotomy, PCNL or laser lithotripsy?
The choice depends on stone size, position, kidney anatomy and your health. A urologist should explain why one technique is recommended for you.
| Technique | Best suited to | Typical limits |
|---|---|---|
| Flexible URS with laparoscopic pyelolithotomy | Large pelvic or branching stones, extrarenal pelvis, a narrowed pelvi-ureteric junction needing repair in the same session | General anaesthesia, two routes, fewer hospitals with the skill |
| PCNL (percutaneous nephrolithotomy) | Large kidney stones, usually over 2 cm | Needs a tract through the kidney; more bleeding risk |
| Flexible URS with laser | Stones up to about 2 cm, no skin cut | Large stones may need several sessions |
See our pages on percutaneous nephrolithotomy and ureteroscopy with laser lithotripsy for the single-route options. Open surgery is now rarely needed for kidney stones.
Who is a suitable candidate, and who is not?
The operation is considered for adults with a large pelvic stone, a stone burden in both the pelvis and calyces, or a kidney whose pelvis sits outside the kidney tissue where an access tract is poorly suited. It is also useful when a blockage at the junction of the pelvis and ureter (pelvi-ureteric junction obstruction) can be repaired at the same time. You may not be suitable if you have an uncontrolled urinary infection, a bleeding disorder or blood thinners that cannot be paused, previous extensive surgery on the same kidney, severe heart or lung disease, or if a simpler method would clear the stone. A CT scan of the urinary tract is normally needed, as ultrasound and X-ray alone often miss detail.
Flexible URS with laparoscopic pyelolithotomy cost in Turkey compared with the UK, US and Germany
These ranges are approximate for the complete operation and a short hospital stay, not hospital quotes. Exact figures depend on stone complexity, operating time, the technology used and the length of stay.
| Country | Approximate cost range |
|---|---|
| Turkey | €3,000 – €7,500 |
| United Kingdom | €6,500 – €13,000 |
| United States | €12,000 – €32,000 |
| Germany | €5,500 – €12,000 |
What changes the price: stone size and number, whether a second procedure (for example repair of a narrowed junction) is added, the length of hospital stay, the laser and scope equipment, and the CT, stent removal and stone analysis. A good package lists the pre-operative scan, surgery, anaesthetist, hospital room, drain and stent, medicines and the planned stent removal. A written free quote lets you compare these items.
What is recovery like, and how long should you stay in Turkey?
Most patients stay in hospital for two to three nights, with the drain removed after a day or two and the urinary catheter taken out soon after the operation. Expect a flank ache, bloody urine and frequency, and stent discomfort, which feels like a need to pass urine and a dull loin ache after voiding. A realistic timeline:
- Days 1 to 3: hospital stay, walking from day one, pain controlled with tablets.
- Days 4 to 7: stay close to the team; check-up and urine results.
- Weeks 1 to 2: desk work usually possible; avoid heavy lifting.
- Weeks 2 to 4: stent removal by a short camera procedure, then follow-up imaging.
Because a stent stays in the ureter for roughly two to four weeks, plan either to stay in Turkey for the removal or to arrange it beforehand with a urologist at home. Flights are normally permitted after the surgeon has checked you, usually after about a week.
What are the risks of this operation?
As with any operation under general anaesthesia, there is a risk of bleeding, infection, blood clots and reactions to the anaesthetic. Specific to stone surgery are urinary tract infection or, rarely, sepsis if infected urine is pushed into the bloodstream, ureteric injury or narrowing, a urine leak after the pelvis is closed, residual fragments needing a second procedure, and injury to nearby organs during laparoscopy. Stent symptoms are common but temporary. The European Association of Urology guidance and the NHS recommend treating any urine infection before surgery and confirming the stone is cleared with imaging afterwards. Ask the surgeon what the conversion plan is if the laparoscopic part cannot be completed.
How can you prevent kidney stones coming back?
Stones often recur if nothing changes. The stone analysis tells you what it was made of, and urine tests can show what is driving it. General advice from the NHS and urology societies includes drinking enough fluid to pass about two to two and a half litres of urine a day, limiting salt and animal protein, keeping calcium intake normal, and treating metabolic causes such as high urate or low citrate. Follow-up imaging a few months after surgery checks for new or residual stones. Ask whether the hospital provides a metabolic work-up and a written plan for your home doctor. Our kidney stone removal page covers the wider choice of treatments.
How to choose a surgeon and hospital, and questions to ask
Look for a urologist trained in both endourology and laparoscopy, a hospital with a CT scanner, a laser, flexible scopes and an intensive-care facility, and a written plan before you pay. Red flags are a recommendation for this combined operation without a CT scan, no discussion of PCNL or laser alone, promises of one-session clearance, and no plan for stent removal. Read how our process works and ask:
- Why is the combined approach better suited to my stone than PCNL or laser alone?
- How many of these operations does the team perform each year?
- What is the chance of a second procedure, and is it included in the price?
- Who removes the stent, and when?
- Is stone analysis and a prevention plan included?
Hospitals with Urology in Turkey
Frequently asked questions
It is a combined kidney stone operation. A flexible scope passed through the urinary tract clears stones in the kidney's calyces, while keyhole surgery opens the renal pelvis and removes the main stone.
Large, branching or awkwardly placed stones can be hard to clear by one route. Using two routes can remove the main stone and the side-calyx fragments in a single anaesthetic, with a smaller kidney injury than a wide tract.
Approximate ranges are €3,000 to €7,500 in Turkey against about €6,500 to €13,000 in the UK. The price depends on stone complexity, stay length and extra procedures, and each hospital confirms it in a written quote.
You are under general anaesthesia. Afterwards expect flank soreness and stent symptoms such as urgency and loin ache when passing urine. Tablets control the discomfort, and most people walk the day after surgery.
Hospital stay is usually two to three nights. Many people return to desk work after one to two weeks and avoid heavy lifting for about four weeks. The stent is removed after roughly two to four weeks.
PCNL goes through a tract in the kidney and suits large stones, with a higher bleeding risk. The combined approach avoids a kidney tract but needs two routes and a surgeon skilled in both.
Yes, a CT scan of the urinary tract is normally needed to show the stone size, position and kidney anatomy. Ultrasound or X-ray alone often misses detail needed to plan the operation.
It is an established technique with known risks including bleeding, infection, urine leak and residual stones. Safety depends on the surgeon's experience and a hospital with intensive-care support.
Yes, stones recur in many people unless the cause is addressed. Stone analysis, enough fluid, diet changes and treatment of metabolic causes reduce the chance.
Plan for about seven days after surgery so the surgeon can check you and the drain and catheter are removed. The stent removal one to four weeks later may need a second visit or a urologist at home.
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