How to cite: Riley J. Tips to Make Ureteroscopy More Successful. Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/tips-to-make-ureteroscopy-more-successful/
Summary
Julie Riley, MD, MBA, MS, FACS, Professor of Urology and Director, Renal Transplantation, University of Missouri, Columbia, Missouri, presents practical tips to improve ureteroscopy success by focusing on factors associated with access failure, residual fragments, infection risk, and inefficiency. Dr. Riley emphasizes that procedural frequency alone does not ensure mastery and argues that successful ureteroscopy requires intentional planning, adaptation, and avoidance of complacency. She defines success as stone-free outcomes, safe access, efficient execution, minimal trauma, low complications, and patient satisfaction.
Dr. Riley identifies common reasons ureteroscopy may fail, including poor planning, underestimation of stone burden or anatomy, forceful access, inadequate pressure control, reluctance to stage procedures, and suboptimal application of laser lithotripsy. She reviews a practical preoperative framework that includes assessment of stone location and size, kidney anatomy, ureter caliber, prostate size, procedural history, and infection risk. She discusses wire selection, use of retrograde imaging and fluoroscopy when needed, and decision-making regarding ureteral access sheaths, emphasizing that difficult access may warrant stenting and staged treatment rather than forcing progression.
Laser lithotripsy is presented as an adaptive rather than fixed strategy. Dr. Riley advocates adjusting settings based on how the stone responds, using a “test bite” approach, flexibility between dusting and fragmentation strategies, and patience to improve efficiency and reduce unnecessary basket extraction.
She also reviews intrarenal pressure as a modifiable risk factor, emphasizing the avoidance of excessive manual irrigation and the recognition of the roles of sheaths and suction technologies. Suction-assisted ureteroscopy is presented as potentially improving stone-free rates and reducing complications. Dr. Riley advocates treating all accessible ipsilateral stones when appropriate and emphasizes that operators should abort before misadventure occurs when safety is at risk.
About the 45th Annual Ralph E. Hopkins Urology Seminar
The Annual Ralph E. Hopkins Urology Seminar, also known as the Jackson Hole Seminars, brings together distinguished urologists, clinical researchers, and thought leaders to share wisdom and experience that drives meaningful progress in patient care. Changes occur in medicine and urology on an almost daily basis, so it is imperative that the practicing urologist remains on the cutting edge. Urologists need to keep current on assessing, diagnosing, and treating urologic conditions in the clinical setting. The 45th meeting took place in 2026, focusing on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. 2026 also marked the meeting’s first-ever all-female speaker panel.
ABOUT THE AUTHOR
Julie Riley, MD, MBA, MS, FACS, is a Professor of Urology, the Director of Renal Transplantation, and Vice Chair of Operations in the Department of Surgery at the University of Missouri in Columbia, Missouri. Her clinical interests include medical and surgical management of kidney stones, laser enucleation of the prostate, ureteral reconstruction, and renal surgery and transplantation. Her research interests include practice management and operations efficiency.
