Post-Ureteroscopy Lithotripsy Hematuria
Yes, blood in the urine (hematuria) after ureteroscopy with lithotripsy is an expected and normal finding that typically resolves with conservative management.
Expected Post-Procedural Finding
Hematuria is a common and anticipated complication following ureteroscopy with laser lithotripsy, occurring in the immediate postoperative period as a result of mucosal trauma from instrumentation and stone fragmentation 1.
In large-scale studies of ureteroscopic procedures, transient hematuria was documented in approximately 4.2% of cases as a recognized complication, though this likely underestimates the true incidence of minor bleeding that resolves without intervention 2.
The manipulation of the ureter and kidney during stone fragmentation inherently causes minor mucosal injury, leading to blood in the urine that is generally self-limited 3, 4.
Management Approach
Conservative management is appropriate for most cases of post-ureteroscopy hematuria, including adequate hydration and observation 3.
If a ureteral stent was placed during the procedure (which is common practice), some degree of hematuria may persist intermittently until stent removal 2, 3.
Frank (gross) hematuria that persists beyond the immediate postoperative period or requires transfusion warrants further evaluation, as this may indicate a more significant complication such as arteriovenous fistula or vascular injury 5, 1.
Red Flags Requiring Urgent Evaluation
Delayed gross hematuria occurring 7-10 days after the procedure may indicate a rare but serious complication such as intrarenal arteriovenous fistula formation, which requires imaging (CT angiography) and potential embolization 5.
Hematuria accompanied by fever, flank pain, or signs of sepsis suggests infection or other complications requiring immediate medical attention 2, 3.
Persistent heavy bleeding requiring blood transfusion is uncommon (occurring in approximately 1.7% of cases) but necessitates urgent urologic consultation 3.
Expected Timeline for Resolution
Most post-procedural hematuria resolves within 24-72 hours with adequate hydration and rest 3, 4.
Microscopic hematuria (blood visible only under microscope) may persist for 1-2 weeks and is not concerning if the patient is otherwise asymptomatic 2, 3.