Kidney stones are common, painful, and highly treatable with modern, minimally invasive techniques when managed by an experienced urologist. Below is an expert, patient-friendly guide designed to maximize clarity, trust, and actionability while aligning with current urology guidelines for high-quality care.
What are kidney stones?
Kidney stones are hard, crystal-like deposits that form when minerals and salts in urine become concentrated and crystallize inside the kidneys, ureter, or bladder, ranging from tiny grains to large staghorn stones that can fill the kidney. Dehydration, high sodium or animal-protein intake, obesity, metabolic conditions, anatomic factors, and family history increase risk, and stones may cause severe flank pain, blood in urine, nausea, vomiting, fever, and urinary obstruction.
When to seek urgent care
Immediate evaluation is recommended for severe flank pain, fever or chills, vomiting, inability to pass urine, or known stones with escalating pain, as obstruction and infection can threaten kidney function and require prompt intervention.
How stones are diagnosed
Guideline-based evaluation includes clinical assessment, urinalysis, serum labs, and imaging, with non-contrast CT as the most sensitive test, and ultrasound or low-dose CT considered to reduce radiation where appropriate. After stone passage or removal, stone analysis and risk stratification guide prevention, with metabolic evaluation prioritized for recurrent or high-risk stone formers.
Can small stones pass naturally?
Selected ureteral stones may pass spontaneously with hydration, analgesia, and, in appropriate cases, medical expulsive therapy, typically using an alpha-blocker for up to 4–6 weeks before definitive treatment is considered. Failure to pass, persistent pain, infection, or impaired renal function are indications to proceed with procedural treatment.
Surgical Treatment Options
Modern stone surgery is safe, effective, and tailored to stone size, location, density, anatomy, and patient preference, balancing stone-free rates, recovery, and risks.
ESWL (Shock Wave Lithotripsy)
ESWL uses focused acoustic shock waves from outside the body to fragment the stone so pieces pass in urine, avoiding incisions and usually performed as day care. It is best suited for selected renal and ureteral stones typically up to 10–20 mm depending on location and stone characteristics, with lower stone-free rates than endoscopic procedures for certain locations like the lower pole. Advantages include noninvasiveness; limitations include variable clearance and the possibility of retreatment or steinstrasse.
Ureteroscopy (URS/RIRS, Flexible Laser)
URS uses a thin scope passed through the urethra and ureter into the kidney to visualize stones, fragment them with laser (Ho:YAG/Thulium), and remove fragments, with high stone-free rates and low major complication risk. Guidelines recommend URS as first-line for many symptomatic ureteral stones and for renal stones up to 20 mm, particularly when ESWL success is predicted to be lower. Most complications are minor; serious events like ureteral avulsion or strictures are rare in experienced hands.
PCNL (Percutaneous Nephrolithotomy)
PCNL removes large or complex stones through a small tract created from the skin into the kidney under imaging guidance, enabling direct fragmentation and extraction. It achieves the highest stone-free rates for burdens >20 mm and staghorn stones and is guideline-recommended first-line for large stone burdens, with minimally invasive variants (mini/ultra-mini PCNL) lowering morbidity while maintaining efficacy. Risks include bleeding, infection, and adjacent organ injury, mitigated by technique, tract size, and perioperative protocols.
Choosing the Right Procedure
Choosing the Right ProcedureTreatment selection is individualized using guideline frameworks that integrate stone burden, location, density, anatomy, comorbidities, radiation considerations, and patient goals, with counseling on trade-offs in stone-free rate, reintervention, anesthesia, and recovery. In comparative evidence, PCNL generally yields the highest stone-free rates for large burdens, URS excels for many ureteral and moderate renal stones with fast recovery, and ESWL remains valuable for select stones when noninvasiveness is prioritized.
Recovery and follow-up
After URS or PCNL, a temporary internal stent may be placed to ensure drainage and healing, with removal planned based on clinical factors, and follow-up imaging confirms clearance and guides next steps if fragments remain. Postoperative care includes hydration, pain control, activity guidance, and infection surveillance, all of which are standardized in modern stone pathways.
Preventing Future Stones
Prevention is essential because recurrence is common without risk-based dietary and medical therapy guided by urine and stone analysis. All stone formers should target fluid intake sufficient to achieve ≥2.5 liters of urine per day, mainly water, as the most consistent preventive measure across guidelines. Nutrition focuses on reducing sodium, moderating animal protein, obtaining adequate dietary calcium (paired with oxalate-containing foods), and adjusting oxalate intake for calcium oxalate stone formers, with individualized plans based on stone type and 24-hour urine testing. Evidence-backed counselling includes limiting high-oxalate foods when indicated, maintaining normal calcium intake from food, and leveraging citrate from citrus to reduce crystallization risk.
What to do next
A urologist-led plan begins with accurate imaging, pain and infection control, and a clear decision between observation and intervention based on guideline criteria, followed by definitive treatment when indicated and a structured prevention strategy to minimize recurrence. For symptomatic stones, timely consultation improves comfort, reduces complications, and shortens the path to being stone-free with durable prevention.
Conclusion
Kidney stones are treatable, and with modern surgical techniques, recovery times are shorter and outcomes better than ever. The key is early diagnosis, individualized treatment, and preventive lifestyle changes.
If you are experiencing symptoms or have been diagnosed with a kidney stone, book an appointment with a qualified Urologist in Indore for a tailored treatment plan.
About the Author
Dr. Yusuf Saifee, MBBS, MS (Gold Medalist), DNB (Urology), is a distinguished Consultant Urologist & Kidney Transplant Surgeon with over a decade of experience and more than 10,000 successful urological surgeries to his credit. Reach out IndiaUrologist Facebook Page