Last updated: Jul 16, 2025Published on: Jul 16, 2025
Click to rate this article!
[Total: 0 Avg: 0]
Table of Contents
Introduction
Kidney stones are hard mineral and salt deposits that form in the kidneys and can travel through the urinary tract. They often cause intense pain, especially when they block the flow of urine or move through narrow passages like the ureter. While some stones may pass naturally in sometime with fluids, others can become lodged, grow too large, or lead to complications such as infections or kidney damage¹. In such cases, surgical procedures for kidney stone removal may be necessary.
Kidney stones affect over 12% of people globally, with high recurrence rates, making kidney stone removal surgery an important option for many². This article explains when kidney stone removal is needed and the options available to ensure safe and effective treatment.
When Is Kidney Stone Surgery Needed?
Kidney stone surgery may be necessary when certain conditions prevent the stone from passing naturally or cause complications. Medical experts have identified the following key situations where active stone removal is recommended3:
Stone larger than 7 mm: Stones over 7 mm in diameter have a very low chance of passing on their own, making surgery the preferred option.
Uncontrolled pain: If you experience severe pain that cannot be relieved with medications, surgical intervention may be needed.
Single or both kidneys obstructed: If the only working kidney is blocked or when both kidneys are blocked, surgery becomes essential to avoid kidney damage.
Infection with obstruction: When a stone blocks urine flow and is also linked to an infection, the risk of serious complications increases, which necessitates surgical removal.
Risk of pyonephrosis (Pus in the kidney) or urosepsis (Infection spreading from the urinary tract into the blood): These are serious infections that can happen if a kidney stone blocks urine flow. They are medical emergencies and require immediate surgical management to remove the pus.
Types of Kidney Stone Removal Procedures
The treatment of kidney stones includes several options depending on size, location, and complexity. Here are the 4 methods for kidney stone removal most commonly used today:
Extracorporeal Shock Wave Lithotripsy (ESWL): A non-surgical method that uses sound waves to break stones into tiny pieces, so they pass naturally in urine. It’s a popular kidney stone removal without surgery option for smaller stones (under 2 cm). It is not ideal for larger stones, those that are hard to break or located in difficult-to-reach areas4.In some cases though, ESWL may need adjunct procedures such as Double J stent (a hollow tube) insertion to facilitate stone fragments removal and prevent obstruction5.
Percutaneous Nephrolithotomy (PNL): Used for removal of large or complex stones, wherein a small cut in the back is made that allows instruments to remove the stone directly from the kidney. It’s minimally invasive and newer tools help lower the risk of complications4.
Ureterorenoscopy (URS): This procedure involves inserting a thin tube into the urinary tract to remove stones. During URS, doctors often perform laser kidney stone removal (lithotripsy) to break stones and remove fragments. Effective when ESWL doesn’t work4.
Open Surgery: Rarely used today. Reserved for very large stones or unusual anatomy when other treatments fail. Keyhole (laparoscopic) surgery is often used instead for quicker recovery4.
For small, uncomplicated stones, increased fluid intake, medications, or ESWL may help the stone pass naturally without surgery.
Table 1: Summary of Kidney Stone Removal Procedures4
Procedure
Invasiveness
Best For
Notes
ESWL
Non-invasive
Stones <2 cm
Uses shock waves to break stones; may not work for all stone locations.
PNL
Minimally invasive surgery
Large or complex stones
Involves a small back incision; newer mini tools reduce risks
URS
Minimally invasive
Mid-size or failed ESWL cases
Uses scope and laser; high success, low risk
Open Surgery
Invasive
Special/complex cases
Rarely needed; laparoscopy preferred when possible
Note: The choice of procedure depends on multiple factors including stone size and type, location, the patient’s anatomy, and previous treatment outcomes. Always consult a urologist to determine the most suitable and effective option for your condition.
Preparing for Kidney Stone Surgery
Proper preparation is important for a safe and successful kidney stone surgery. This usually involves pre-operative testing, imaging, and sometimes medication adjustments. However, in certain situation special precautions need to be taken. Let’s have a look at these.
Imaging Tests: Before surgery, doctors usually perform imaging to locate stones and assess the urinary tract. Noncontrast CT (NCCT) is the most sensitive test for kidney and ureteric stones and is recommended before certain surgeries like percutaneous nephrolithotomy (PCNL). Ultrasound is preferred initially, especially for children and pregnant women, to reduce radiation exposure. Contrast imaging may be needed if anatomy details are required.
Urine Tests: Urine analysis detects infection, blood, and inflammation. If infection is suspected, urine culture and microscopy are performed to guide antibiotic use.
In cases of suspected infection or solitary kidney, urgent and careful evaluation is required.
For bladder stones, ultrasound is the first-line imaging, with further imaging or cystoscopy if symptoms persist.
For children and pregnant women, radiation exposure is minimized by prioritizing ultrasound and using low-dose imaging only if necessary.
2. Preparing for the Procedure
Fasting and Medication Adjustments: Patients may be asked to fast before surgery to reduce anaesthesia risks. Any blood-thinning medications or other drugs may need adjustment, guided by the healthcare provider5.
In pregnancy, doctors usually prefer conservative treatment to avoid risk to mother and baby. If necessary, a team of specialists plans a safe approach, often involving temporary drainage or ureteroscopy.
Children are treated similarly to adults but with care tailored to their needs. Shockwave therapy is commonly used for stones under 10 mm. More invasive methods are considered only if conservative treatment fails.
What to Expect During Kidney Stone Removal
Kidney stone treatment varies depending on the size, location, and overall health. Understanding what to expect before, during, and after the procedure can help ease anxiety and support a smoother recovery.
During the Procedure
Anaesthesia: Most kidney stone procedures are done under anaesthesia to ensure comfort. The type, local, regional, or general, depends on the procedure’s complexity5.
Imaging Guidance: Doctors use ultrasound, X-rays, or fluoroscopy during the procedure to accurately locate and treat the stone while minimizing harm to surrounding tissues5.
Surgical Technique: Depending on the procedure, you may expect a non-invasive session (like shock wave therapy)5 or small incisions in the back or abdomen for stone removal. Scopes or lasers may be used to remove or break stones internally6.
Stent Placement: A ureteral stent (a thin tube placed in the ureter) may be inserted to relieve blockage, especially in cases of infections or large stone burdens5.
After the Procedure
Common Post-Surgery Symptoms: You may experience the following temporary symptoms7:
Soreness or bruising at the site if ESWL (shockwave therapy) was used.
Blood in urine and urinary discomfort, especially if a ureteral stent is placed.
Pain and nausea as leftover stone fragments pass naturally.
Incision pain if the procedure involved a surgical cut (e.g., PNL).
Post-Operative Care and Recovery
After kidney stone removal, proper care is important for healing and preventing future stones5:
Pain Relief: Most people can manage discomfort with commonly used pain relievers like anti-inflammatory or non-opioid medications. Stronger painkillers may be used only if needed, although you must be cautious when kidney function is impaired. So, do not self-medicate and consult your doctor for the right pain relief medication.
Stay Hydrated: Drinking plenty of fluids helps flush out any leftover stone fragments and lowers the risk of new stones forming.
Rest: Avoid heavy lifting or intense activities during the recovery period.
Follow-Up: A scan (ultrasound or CT) is usually done about 4 weeks after treatment to check for any remaining stone pieces. Additional treatment may be needed if fragments are still present.
Medications: In some cases, doctors may prescribe medicines to help pass stone fragments or to treat infection if present.
Lifestyle Changes: Following a healthy diet and going for regular checkups can help prevent stones from coming back.
These are essential to ensure complete stone clearance and healing.
Recovery time depends on the treatment:
Laser or scope-based procedures (URS): Most people recover within 3-4 days7.
Minimally invasive surgery (PCNL): Recovery may take about 1 week8.
Shock wave treatment (ESWL): Non-surgical method so usually allows fast recovery. Most people return to normal activities within 1–4 days8.
Complications of Kidney Stone Surgery
Like any other procedure, kidney stone removal surgery may have some risks and complications, including7,9,10:
Fever and Infection: Patients may develop fever, often indicating an infection that needs treatment.
Injury: Parts of urinary tract may get tears or perforation.
Urine Leakage (Extravasation): Urine may leak outside the urinary tract temporarily.
Ureteral Obstruction: Ureters may get blocked by broken and dislodged stone fragments.
Bleeding: Excessive bleeding may require blood transfusion.
Non-invasive procedures like shock wave lithotripsy are generally considered safe, and studies have shown that surgical procedures such as Percutaneous Nephrolithotomy have a higher risk of complications8.
Other possible complications of these procedures include7,9,10:
Urethral Strictures (stiffness in ureters)
Sepsis (Spread of infection to blood)
Damage to extrarenal organs (such as bowel, liver or pancreas)
Air or fluid around the lungs (pneumothorax or hydrothorax)
Lung infection or collapse (pneumonia or atelectasis)
Escape of stone fragments into surrounding tissues
In some cases, additional surgery may be required to repair injuries or control bleeding if other treatments are not effective.
Although complications can occur, kidney stone surgery is generally safe, and your healthcare team will closely monitor you to manage any problems quickly.
Can Kidney Stones Recur After Surgery?
Kidney stones can come back even after successful removal. In fact, for those who have already had a kidney stone, the risk of having another one is quite high, between 60 and 80 percent.
Though the reasons for stones returning are not fully clear, factors like climate, the mineral content in drinking water, diet, and genetics may play a role11. Recurrent kidney stones are one of the common risk factors for chronic kidney disease and end stage kidney disease requiring dialysis and transplant12. Especially for children with stone, special care is needed along with a proper evaluation for genetic and metabolic disorders11. Thus, preventing recurrence is important and requires appropriate investigation and management tailored to the individual needs, beyond just treating the acute pain.
Tips for Preventing Future Kidney Stones
Preventing kidney stones is possible with straightforward daily habits and targeted strategies. Here’s how you can significantly reduce your risk13:
Drink Plenty of Fluids: Not drinking enough water is a major cause of kidney stones. Try to drink 2.5 to 3 liters (about 10–12 cups) of fluid every day so you make plenty of urine. This helps flush out substances that form stones.
Adopt Healthy Lifestyle Habits: Keep your weight in a healthy range and stay active. If you work or exercise in the heat, drink more water to replace fluids you lose through sweat. Avoid smoking and secondhand smoke.
Follow a Kidney-Friendly Diet: Get enough dietary calcium (1000–1200 mg/day), limit salt to 2 grams daily, reduce animal protein intake, and increase plant-based proteins. If you’ve had calcium oxalate stones, avoid high-oxalate foods like spinach and certain nuts.
Add More Citrus Fruits: Fruits like lemon, lime, and grapefruit and supplements like lime powder can increase urinary citrate and help prevent stone formation.
Take Medicine as Advised: Some people need medications to prevent stones. These may include water pills (thiazides), potassium citrate, or allopurinol. Your doctor will decide what’s right for you and check for any side effects.
Treat and Prevent Infections: If your stones are related to infections, you may need antibiotics and full stone removal. Long-term antibiotics aren’t always safe, so your doctor will carefully monitor their use.
When to See a Doctor
Kidney stones don’t always require medical treatment, but there are times when you should seek help right away. Contact a doctor if you experience any of the following14:
Sudden, severe flank pain, often starting at night or early morning.
Pain spreading to the genitals (testis or vulva).
Continuous, steady pain that progressively worsens and wakes you from sleep.
Pain onset following heavy exercise.
Nausea and vomiting accompanying the pain.
Visible blood in urine.
Fever and chills during kidney stone pain.
Low blood pressure with pain.
Kidney stone pain is often described as one of the most severe types of pain, usually rated 9 or 10 out of 10. If you feel this type of pain, don’t wait, get medical help immediately.
Conclusion
Timely kidney stone removal is essential to prevent severe pain, infection, and kidney damage. Minimally invasive procedures effectively clear stones and restore urine flow, while proper recovery includes pain control, hydration, rest, and follow-up imaging to ensure all fragments are removed. Surgery alone doesn’t stop stones from coming back, so prevention is key. Drinking plenty of fluids, maintaining a healthy lifestyle, following a kidney-friendly diet, and taking prescribed medications help reduce recurrence risk. Early recognition of symptoms and prompt medical care improve outcomes and avoid serious complications. Combining timely treatment, careful recovery, and prevention strategies supports long-term kidney health and reduces the chance of future stones, helping patients maintain quality of life.
Frequently Asked Questions (FAQs)
What are kidney stones?
Kidney stones are hard crystalline structures that form in one or both of your kidneys when high levels of certain minerals are present in your urine. They can vary in size and may cause severe pain if they block the flow of urine1.
What causes the pain in kidney stones?
The pain starts when a stone moves into the tube (ureter) that carries urine from the kidney. This leads to a sharp, steady pain known as renal colic14.
How quickly does the pain peak?
About one-third of patients reach peak pain in 30 minutes or less. Most people seek medical help within two hours due to the intensity14.
Can kidney stones lead to other health problems?
Yes. Kidney stones can raise the risk of high blood pressure, heart disease, and kidney damage12.
Who has a higher risk of kidney damage from stones?
People who have repeated infections, urinary tract problems, or certain genetic conditions are more at risk12.
Is ureteroscopy with laser lithotripsy effective?
Yes. This treatment clears stones in more than 90 out of 100 people. It works well even for medium-sized stones and is commonly used for stones in the upper part of the urinary tract7.
Is a stent always used after Ureteroscopy?
Not always, but it’s commonly placed to prevent swelling and aid healing. Sometimes it’s also placed before the procedure if there’s a blockage or infection7.
How effective is ESWL compared to other treatments?
ESWL may be less effective than PCNL in clearing stones within three months. Patients treated with ESWL were less likely to achieve success than those treated with PCNL8.
Does ESWL have fewer complications?
ESWL probably leads to fewer complications than PCNL8.
Is hospital stay shorter with ESWL?
Yes. Studies8 showed that hospital stay is shorter for patients undergoing ESWL compared to those having PCNL.
References
Song L, Maalouf NM. Nephrolithiasis. [Updated 2020 Mar 9]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279069/
Leslie SW, Sajjad H, Murphy PB. Renal Calculi, Nephrolithiasis [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [updated 2024 Apr 20; cited 2025 Jun 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442014/
Hughes T, Ho HC, Pietropaolo A, Somani BK. Guideline of guidelines for kidney and bladder stones. Turk J Urol. 2020 Nov;46(Supp. 1):S104-S112. doi: 10.5152/tud.2020.20315. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7731951/
Mbaeri TU, Amos Onu O, Odo C, Victor Nwadi U. Ureteroscopy and Holmium:YAG Laser Lithotripsy For Upper Tract Stones in a New Urology Centre: Our Initial Experience. Niger Med J. 2023 May 11;64(2):259-266. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11185812/
Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, Pattanittum P. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev. 2023 Aug 1;8(8):CD007044. doi: 10.1002/14651858.CD007044. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10392035/
Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, Cantos E. Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol. 1987 Jan;148(1):177-80. doi: 10.2214/ajr.148.1.177. Available from: https://pubmed.ncbi.nlm.nih.gov/3491509/
D’Addessi A, Vittori M, Racioppi M, Pinto F, Sacco E, Bassi P. Complications of extracorporeal shock wave lithotripsy for urinary stones: to know and to manage them-a review. Scientific World Journal. 2012;2012:619820. Available from: http://pmc.ncbi.nlm.nih.gov/articles/PMC3317539/
Morton AR, Iliescu EA, Wilson JW. Nephrology: 1. Investigation and treatment of recurrent kidney stones. CMAJ. 2002 Jan 22;166(2):213-8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC99277/
Favus MJ, Feingold KR. Kidney Stone Emergencies. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-[updated 2018 Sep 13; cited 2025 Jun 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278956/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Comments