Kidney Stone Treatment Options
Kidney stones can be treated in several different ways. Some stones can be monitored or allowed time to pass naturally, while others may require shock-wave treatment, ureteroscopy and laser surgery, PCNL or urgent drainage of the kidney.
Fever with an obstructing kidney stone needs urgent assessment
Seek urgent medical care if kidney stone symptoms are accompanied by fever, chills, significant illness or inability to pass urine. An infected obstructed urinary system can require urgent drainage rather than routine elective stone treatment.
Is there one best treatment for kidney stones?
No. The appropriate treatment depends on the stone and the person rather than one technique being suitable for everyone.
A small ureteric stone may pass naturally. A selected renal stone may be suitable for observation or shock-wave lithotripsy. Other stones may be better approached using ureteroscopy or PCNL.
The first step is therefore to understand the size, location and overall stone burden and whether the stone is causing pain, obstruction or infection.
What determines which treatment is appropriate?
Stone treatment is chosen after considering several factors together.
Stone Size
Increasing stone size can reduce the likelihood of spontaneous passage and influence which procedures are practical.
Stone Location
Stones within the kidney, upper ureter and lower ureter may have different treatment options.
Symptoms
Persistent renal colic or other significant symptoms can favour active stone treatment.
Obstruction
Ongoing blockage of urine drainage from the kidney is an important consideration when deciding whether intervention is required.
Infection
Infection changes the urgency and sequence of treatment, particularly when the urinary system is obstructed.
Kidney & Patient Factors
Kidney anatomy, function, previous surgery, medications, general health and patient circumstances can all influence treatment.
What are the main ways kidney stones are treated?
The treatment pathway ranges from observation through to endoscopic or percutaneous stone surgery.
Observation & Follow-Up
Not every kidney stone requires immediate treatment. Selected stones can be monitored when they are not causing concerning symptoms, infection or obstruction.
- Suitable for selected stable stones
- May involve follow-up imaging
- Treatment can be reconsidered if the stone grows or becomes symptomatic
Allowing a Ureteric Stone to Pass
Selected smaller ureteric stones may be given time to pass naturally if symptoms are manageable and complications are not developing.
- More relevant for smaller stones
- Stone location influences passage
- Follow-up may be required to confirm passage
Shock Wave Lithotripsy
Shock-wave lithotripsy uses externally generated acoustic waves to fragment selected urinary stones so that the resulting pieces can pass through the urinary tract.
- No endoscope is passed into the kidney
- Suitability depends on stone size, position and density
- More than one treatment session may sometimes be needed
Ureteroscopy & Laser Surgery
Fine telescopes are passed through the urinary tract to reach the stone. Laser energy can then be used to fragment the stone and selected fragments can be removed.
- No external skin incision
- Used for many ureteric and renal stones
- A temporary ureteric stent may sometimes be required
PCNL
Percutaneous nephrolithotomy creates a small tract directly into the kidney through the back or side, allowing larger volumes of stone to be treated and removed.
- Important for larger renal stone burdens
- Often used for complex or staghorn stones
- Can sometimes require staged treatment
Kidney Drainage
Sometimes the immediate priority is not to remove the stone but to restore urine drainage from the kidney. This can be achieved with a ureteric stent or nephrostomy.
- May be needed for infected obstruction
- Can relieve urinary blockage
- Definitive stone treatment may occur later
How do kidney stone treatments differ?
This simplified comparison is a starting point. Individual suitability depends on the stone and clinical circumstances.
| Treatment | How the stone is approached | Common role | Temporary stent? |
|---|---|---|---|
| Observation | No procedure | Selected stable or asymptomatic renal stones | No |
| Spontaneous Passage | Stone passes naturally | Selected smaller ureteric stones | Usually no |
| Shock Wave Lithotripsy | Shock waves generated outside the body | Selected kidney or ureteric stones | Sometimes |
| Ureteroscopy | Through the urethra, bladder and ureter | Many ureteric and renal stones | Sometimes |
| PCNL | Small tract directly into the kidney | Larger and more complex renal stones | May be used |
| Urgent Drainage | Ureteric stent or nephrostomy | Obstruction requiring drainage, including infected obstruction | The stent may itself provide drainage |
When is ureteroscopy considered?
Ureteroscopy is commonly used when a ureteric stone needs active removal and can also treat many stones within the kidney.
The ureteroscope passes through the natural urinary tract, avoiding an external incision. Flexible instruments can travel into the kidney and laser energy can be used to fragment selected stones.
For larger renal stone burdens, however, PCNL may provide a more appropriate route for stone removal.
When is PCNL considered?
PCNL creates direct access through a small tract into the kidney and allows stone material to be removed through that tract.
It is particularly important for larger renal stone burdens, staghorn stones and other complex stones where a direct percutaneous approach may be more appropriate.
Current international guidance generally recommends PCNL as the principal treatment when active removal is required for renal stones above approximately 2 cm.
What if the kidney is blocked and infected?
This is different from routine elective stone treatment. When infection occurs behind an obstructing stone, attempting immediate definitive stone removal may not be the first priority.
The kidney may first need to be drained with a ureteric stent or nephrostomy, together with treatment of the infection. Definitive treatment of the stone can then be planned once the infection has settled.
How is the final treatment decision made?
Review Imaging
Establish the size, location, number and distribution of the stones and whether obstruction is present.
Assess Clinical Risk
Consider pain, infection, kidney function, previous stone episodes and the likelihood of spontaneous passage.
Compare Options
Discuss observation, SWL, ureteroscopy, PCNL or other pathways that are relevant to the particular stone.
Plan Prevention
For recurrent or higher-risk stone formers, consider stone analysis and metabolic assessment after the acute stone has been addressed.
Treatment does not end when the stone is removed
Stone surgery treats the current stone burden but does not necessarily remove the underlying tendency to develop stones.
Patients with recurrent or higher-risk kidney stones may benefit from stone analysis, blood testing and 24-hour urine assessment to identify potentially modifiable risk factors.
Kidney stone treatment pathways
When Does a Kidney Stone Need Surgery?
Understand when observation may be reasonable and when active treatment becomes more appropriate.
Can My Stone Pass Naturally?
Learn how stone size and location influence spontaneous passage and when intervention may be needed.
Staghorn Kidney Stones
Learn about branching kidney stones, infection risk and the role of PCNL and staged stone treatment.
Kidney Stone Treatment FAQs
What is the best treatment for a kidney stone?
There is no single best treatment for every stone. Treatment depends on stone size, location and density, symptoms, obstruction, infection, kidney anatomy, previous treatment and individual circumstances.
Can kidney stones be treated without surgery?
Yes. Selected renal stones can be observed, and many smaller ureteric stones can pass naturally. Shock-wave lithotripsy can also treat selected stones without passing a telescope into the kidney.
What is laser kidney stone surgery?
Laser stone surgery usually refers to ureteroscopy in which a fine telescope is passed through the urinary tract to the stone. Laser energy can then fragment or dust the stone under direct vision.
What is the difference between ureteroscopy and PCNL?
Ureteroscopy reaches the stone through the urethra, bladder and ureter. PCNL creates a small tract through the skin directly into the kidney and is particularly useful for larger or more complex renal stone burdens.
What size kidney stone needs PCNL?
PCNL is generally the principal first-line surgical approach when active removal is required for renal stones greater than about 2 cm. Stone distribution, anatomy, infection and individual circumstances also influence treatment.
Is shock-wave treatment better than ureteroscopy?
Neither is universally better. Shock-wave lithotripsy is less invasive but its effectiveness depends strongly on factors such as stone size, location and density. Ureteroscopy provides direct endoscopic access to the stone but involves instrumentation of the urinary tract.
Will I need a ureteric stent after stone surgery?
Not every patient requires a stent. A temporary ureteric stent may be inserted when additional drainage or ureteric healing is considered helpful.
Can a kidney stone require more than one operation?
Yes. Larger or more complex stone burdens may require staged treatment. More than one procedure can also be required when complete stone treatment during a single operation is not appropriate.
When is kidney stone treatment an emergency?
An obstructed urinary system associated with infection can be a urological emergency. Fever, chills or significant illness with suspected obstruction should prompt urgent medical assessment.
Can kidney stones come back after surgery?
Yes. Removing a stone does not necessarily remove the tendency to form future stones. Recurrent stone formers may benefit from further metabolic investigation and prevention strategies.
Not sure which kidney stone treatment is appropriate?
Existing imaging can be reviewed together with your symptoms, kidney function and stone history to determine whether observation, shock-wave treatment, ureteroscopy, PCNL or another pathway may be appropriate.
This information is general educational information and does not replace individual medical advice. Kidney stone treatment depends on factors including stone size and location, total stone burden, symptoms, obstruction, infection, kidney function, anatomy, previous treatment, medications and individual clinical circumstances.