Unlike traditional rigid ureteroscopes, fiberoptic ureteroscope is a soft endoscope with an apex that can be bent at will, so it can reach areas inside the kidney that cannot be reached by traditional rigid ureteroscopes. Without causing any body surface damage, fiberoptic ureteroscopy can perform lithotripsy of kidney stones. Since the fiberoptic ureteroscope is slightly thicker than the normal ureter, it needs to be pre-treated with ureteral dilatation before the lithotripsy procedure so that the endoscope can reach the kidney very smoothly during the procedure and avoid serious complications from damage to the ureter. The most effective way to pre-dilate the ureter is to place a stent in the ureter, which is clinically known as a “double pigtail” or “double J tube”. Ureteral stenting can be done through an outpatient cystoscope. The ureteral stent is left in the ureter for more than 2 weeks to adequately and passively dilate the ureter. A standard fiberoptic ureteroscopic lithotripsy procedure at Beijing Friendship Hospital is as follows: 1. An outpatient appointment is made for an outpatient cystoscopy to place the ureteral stent and an admission for fiberoptic ureteroscopic lithotripsy 2 weeks thereafter. You will need to be tested for Hepatitis B, Hepatitis C, HIV, Syphilis, and keep the results for all subsequent outpatient and inpatient procedures, and an inpatient lithotripsy order will be issued for this visit. 2. Ureteral stents will be placed for outpatient cystoscopy from 9:00 a.m. to 12:00 p.m. Every Tuesday, you need to drink more water before cystoscopy. There is no drainage tube on the body surface after the stent is left in place, and it does not affect daily activities. It is best to drink more than 3 liters of water per day and drink pure water, not mineral water. Some patients may experience complications such as lumbar distension, painful urination, urinary urgency, urinary frequency, and hematuria during the indwelling ureteral stent, and no special treatment is required. (The outpatient operating room is located on the 5th floor of the outpatient clinic.) 3. 2 weeks after the indwelling ureteral stent, patients will be admitted to the hospital for fiberoptic ureteroscopic lithotripsy, and the duration of this admission will be about 3-5 days, depending on the difficulty of the operation and complications. The ureteral stent will be placed again after the fiber ureteroscopic lithotripsy surgery to facilitate the discharge of stone debris and to keep the ureter open and avoid urinary tract infection. 4.If there are no special circumstances, the ureteral stent will be removed from the patient’s body 2 weeks to 1 month after surgery. In 2 weeks to 1 month after surgery, outpatient review is required to schedule an outpatient cystoscopy to remove the double pigtail tubes. 5. Patients with very large stones may require 2 or more procedures to break up all the stones, with 2-4 weeks between each procedure. Note: Fiberoptic ureteroscopy is a lithotripsy procedure, not a stone removal procedure. Large stones in the patient’s body are broken up by the holmium laser through the fiberoptic ureteroscope, resulting in a large number of stone fragments 1-2 mm in diameter. Most of the stone fragments are actively flushed out of the patient’s body during the procedure, but a small percentage of stone fragments remain in the kidney and ureter and need to be expelled after the procedure. The methods to promote stone discharge are: ① increase the amount of water to drink, for patients after fiber ureteroscopic lithotripsy, if there is no contraindication, it is better to drink more than 3 liters of pure or distilled water daily, not mineral water, tap water and other water containing more ions; ② more exercise to promote the discharge of stones in the ureter; ③ for stones located in the lower renal calyces, the stones need to be first moved up into the renal pelvis and then fall into the ureter (3) For stones located in the lower renal calyces, they need to be moved up into the renal pelvis before falling into the ureter. The patient should lie prone on the bedside with the upper body out of the bed and keep the head as close to the ground as possible, so that the upper body is in a head-low, waist-high position, and then have someone else strike the middle of the patient’s back (the 12th rib and the spinal column angle) for 10-20 seconds, walk and jump upright for 10-20 minutes, then lie prone on the bedside with the head low again and strike the back. This cycle is repeated 4-5 times/day. After all surgeries are completed, you need to maintain the habit of drinking more water, low protein diet, try not to eat tofu or soy products, exercise more, and for uric acid stones you need to visit the rheumatology department to lower the blood uric acid level by taking medication, avoid eating animal offal and not drinking beer.