Prof. Dr. Emel Akoğlu
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- 57+years exp.
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Kidney Stones
Urethroscopic lithotripsy
What urethroscopic lithotripsy is, how a scope passed through the urethra and bladder reaches a stone and breaks it with laser or pneumatic energy, which stones it suits, what the evidence says about stone clearance, approximate costs in Turkey against the UK, US and Germany, recovery with a stent, risks and how to choose a urology team.
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Prof. Dr. Zerrin Biçik Bahçebaşı
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Urethroscopic lithotripsy in Turkey: what it is and how it works
Urethroscopic lithotripsy is a keyhole procedure in which a thin telescope is passed along the urethra and through the bladder to reach a stone, which is then broken into fragments or lifted out. No cut is made in the skin. The name is used in Turkey and on many clinic sites for what urologists elsewhere usually call ureteroscopy with lithotripsy: the scope goes up the ureter, the tube between kidney and bladder, and energy from a laser or a pneumatic probe fragments the stone. The same approach is used for stones sitting in the urethra or bladder itself.
Most people search for it after a scan has shown a stone that has not passed, or after painful colic. This guide explains how the operation works, what the evidence says, who it suits, what it costs in Turkey compared with the UK, US and Germany, how recovery goes and how to check a hospital. For the wider field see our urology treatments in Turkey.
How are stones broken up through the urethra?
The surgeon works under direct vision on a screen. A semi-rigid scope, often only 3 to 4 mm across, travels through the urethra into the bladder, finds the opening of the ureter and is advanced to the stone. A thin guidewire is usually placed first as a safety rail. Water irrigation keeps the view clear.
- Holmium laser: a fibre fired against the stone breaks it by heat and vibration. Settings can create fine dust or larger pieces that are removed with a basket.
- Thulium fibre laser: a newer laser used in some Turkish centres, with a finer fibre and the same aim of dust or small fragments.
- Pneumatic or ballistic probe: a metal rod that taps the stone; it is cheaper and still used for ureteric stones, although fragments can move upwards more easily.
- Basket extraction: a small wire cage that grips fragments and withdraws them through the scope.
Operating time ranges from about 20 minutes for a small stone low in the ureter to over an hour for a hard or impacted stone.
Does urethroscopic lithotripsy work? What the evidence says
It has some of the most thoroughly documented results in stone surgery. Guidelines from the European Association of Urology and the American Urological Association support ureteroscopy as a first-line option for ureteric stones, and as the usual choice when shock wave treatment has failed or is unsuitable. Because the stone is seen and treated directly, clearance after one operation is high for stones in the lower and middle ureter, and somewhat lower for large stones high in the ureter or in the kidney, where a second session is sometimes needed.
What is less certain is the choice of device. Laser fibres break hard stones more efficiently than pneumatic probes, but individual outcomes depend on stone size, hardness, position and the surgeon's experience more than on the brand of laser. A clinic should be able to tell you the expected chance of a single-session clearance for your stone, and what happens if fragments remain. It will not promise that you can never form another stone: recurrence depends on diet, fluid intake and metabolism, and a urine test afterwards is worthwhile.
Which stones can be treated, and which need another route?
The method suits stones in the lower, middle and upper ureter, stones in the bladder and urethra, and many small kidney stones when a flexible scope is used. It is often chosen for people who cannot have shock waves, such as those who are pregnant, on blood thinners, very overweight, or who have a hard stone or a narrowing below the stone. It is less suited to very large kidney stones, usually over about 2 cm, which are generally approached through the back by percutaneous surgery.
You are not an easy candidate if you have an untreated urinary infection, which must be cleared first, or a bleeding disorder that cannot be controlled. A narrow ureter or a past urethral stricture can make passing the scope difficult; for stricture problems see our guide to internal urethrotomy. A urologist will review your CT scan and urine culture before agreeing a plan. A pre-operative look inside the bladder is covered in our guide to cystoscopy.
Urethroscopic lithotripsy cost in Turkey compared with the UK, US and Germany
The ranges below are approximate figures for one operation, not hospital quotes. They vary with stone position, the laser used, whether a stent is placed, day-case or overnight stay and what the package covers. Each hospital confirms its own price in a written quote.
| Country | Approximate cost range |
|---|---|
| Turkey | €1,500 – €4,500 |
| United Kingdom | €3,500 – €8,000 |
| United States | €6,000 – €20,000 |
| Germany | €3,500 – €8,500 |
A single-stone operation is at the lower end; a hard, impacted stone, both sides treated in one session or a longer stay sits higher. A package normally includes pre-operative blood tests and a urine culture, the CT review, the operation with anaesthetist, the laser fibre and disposables, the stent, one or two nights, medication and airport transfers. Check whether the later stent removal is included and whether a stone analysis is done, since both are sometimes billed separately.
Urethroscopic lithotripsy, shock wave lithotripsy or PCNL?
These are the three common ways to clear a stone, and the right one depends on its size and position. Shock wave lithotripsy (ESWL) breaks the stone from outside the body and avoids anaesthesia in many cases but is less effective on hard stones. Percutaneous nephrolithotomy (PCNL) removes large kidney stones through a small cut in the back. Scope-based lithotripsy sits between them. If you are reading about the laser itself, see laser lithotripsy.
| Method | Suits | Typical limits |
|---|---|---|
| Urethroscopic or ureteroscopic lithotripsy | Ureteric and bladder stones, small kidney stones, hard stones | Needs general or spinal anaesthesia; usually a temporary stent |
| Shock wave lithotripsy (ESWL) | Small, softer stones in the kidney or upper ureter | Lower clearance on hard or lower-pole stones; repeat sessions possible |
| PCNL | Large or complex kidney stones | Operation through the back; longer stay and more bleeding risk |
What happens on the day, step by step
You will have blood tests, a urine culture and a CT scan before the operation, and are asked to stop certain medicines such as blood thinners only on the advice of the team. On the day you are under general or spinal anaesthesia, lying on your back with legs supported. The surgeon passes the scope, locates the stone, fragments it and removes the pieces with a basket or lets small dust pass. A fine tube called a ureteric stent is commonly left in place to keep the ureter open while it settles; see ureteral stenting for how it is placed and removed. A catheter may stay in the bladder overnight. Total hospital time is usually one night.
Urethroscopic lithotripsy recovery: stent, symptoms and how long to stay in Turkey
Most people leave hospital the next day and rest for two to three days. Blood in the urine, a burning feeling when passing urine, frequency and an ache in the flank on the stent side are common while a stent is in place and are managed with painkillers and, sometimes, tablets that relax the ureter. Drink enough water to keep the urine pale. Desk work is usually possible within a week; heavy lifting and hard exercise wait for about two weeks or as advised.
The stent is removed by a short telescope check, normally after one to two weeks, so many visitors plan about five to eight nights in Turkey, or choose a hospital that fits the stent with a thread so removal can be arranged at home. Ask which option applies, and take a copy of the operation note, scan and stone report. Flying is generally allowed once you are comfortable and the surgeon agrees, but a stent can cause urgency on the flight.
What are the risks, and when should you seek help?
Possible effects are blood in the urine, stent discomfort, urinary infection, a small ureteric injury or, rarely, a narrowing of the ureter later on. Fragments can remain and cause another colic, which is why follow-up imaging is advised. Fever, shaking chills, worsening flank pain or being unable to pass urine after the operation need urgent medical help, in line with the NHS advice on kidney stones. Quality sources including the EAU and NHS stress that infection must be treated before surgery and that a stent must not be forgotten: it needs removal or exchange on a set date.
How to choose a urology team, and questions to ask the hospital
Check that the operation will be done by a specialist urologist in a licensed hospital with an anaesthetist, CT imaging and a plan for the stent. Red flags include a price quoted without seeing your scan, a promise that a stone will never come back, no mention of stent removal and pressure to pay a deposit quickly. Read how our process works and request a plan through our free quote page.
- Which laser or probe will be used for my stone, and what chance is there of clearing it in one session?
- Will a stent be placed, when is it removed and is that included in the price?
- Is the stone analysed, and will I receive a prevention plan?
- What happens if fragments remain or I develop a fever after I fly home?
- Will I receive the operation note and imaging on disc or by secure link?
Hospitals with Urology in Turkey
Frequently asked questions
It is a keyhole operation in which a thin scope is passed along the urethra and bladder, sometimes into the ureter, to reach a stone. The stone is broken with laser or pneumatic energy and the fragments are removed or left to pass. No skin cut is made.
For stones in the ureter and bladder it has a high chance of clearing the stone in one operation, and guidelines support it as a first-line option. Large, hard stones high in the ureter or kidney may need a second session.
Approximate ranges are about €1,500 to €4,500 in Turkey, against roughly €3,500 to €8,000 in the UK. The price depends on stone size and position, the laser, the stent and the length of stay, and is confirmed in a written quote.
The operation is done under general or spinal anaesthesia. Afterwards a stent can cause an ache in the flank, burning and blood in the urine for one to two weeks. Painkillers and plenty of water usually keep this manageable.
Most people leave hospital after one night and return to desk work within about a week. Heavy lifting and hard exercise wait around two weeks. Symptoms from the stent usually ease soon after it is taken out.
Often yes. A thin tube is commonly left in the ureter for one to two weeks to keep it open while it heals. It is removed with a short telescope check or by a thread, and the surgeon explains which applies.
In most clinics the two terms describe closely related scope-based operations. Ureteroscopy is the usual medical name when the scope reaches the ureter or kidney, so ask the team exactly where the scope will go.
Shock waves work from outside the body and suit small, softer stones. The scope route suits hard stones, stones low in the ureter and people who cannot have shock waves. Your scan and the urologist decide.
Yes. Treatment removes the stone, not the tendency to form one. Drinking enough water, adjusting diet and a stone analysis with a urine test can lower the chance of another stone.
Many people plan five to eight nights so the team can check healing and remove the stent. If a thread stent is used and removal is arranged at home, a shorter stay of about three nights may be possible.
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