A kidney stone is a solid deposit that forms when certain substances in urine become concentrated and form crystals.
Not every kidney stone needs immediate removal.
Some small stones may pass naturally, while others can remain in the kidney without causing symptoms. Active treatment becomes more important when a stone causes persistent pain, urinary obstruction, recurrent infection, bleeding, kidney-function problems or is unlikely to pass on its own.
The right kidney stone removal treatment depends on more than the stone's size. Its location, composition or density, anatomy, symptoms, obstruction and the patient's overall health all influence the treatment decision.
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides specialist evaluation of kidney-related problems and can help assess kidney function and coordinate appropriate care when stone removal is required.
Does Every Kidney Stone Need to Be Removed?
No.
A doctor may recommend observation for a small, asymptomatic stone when there is no significant obstruction, infection or kidney-function concern.
Active removal may become appropriate when there is:
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Persistent or recurrent pain
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Urinary obstruction
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Recurrent urinary infection
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Increasing stone size
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Bleeding associated with the stone
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Reduced kidney function related to obstruction
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Low likelihood of spontaneous passage
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A stone in a location where future complications are a concern
The decision should be individualized rather than based solely on the measurement of the stone.
How Doctors Decide Which Removal Method to Use
Before selecting a procedure, the treating team may consider several questions:
Where Is the Stone?
A stone inside the kidney may be approached differently from a stone lodged in the ureter.
How Large Is It?
Larger stones generally have a lower chance of passing naturally and may require an active removal procedure.
How Dense Is the Stone?
Stone density on CT can influence the expected response to shock wave treatment.
Is There an Obstruction?
Obstruction can change the urgency and treatment approach.
Is There an Infection?
An infected obstructed urinary system requires urgent management. Definitive stone removal may need to wait until the infection has been appropriately controlled.
How Is the Kidney Function?
Creatinine and eGFR can help determine whether the stone is affecting kidney function or whether other kidney problems are present.
Kidney Stone Removal Options
Depending on the clinical situation, treatment may include:
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Observation and medical management
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Shock wave lithotripsy
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Ureteroscopy with laser lithotripsy
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Flexible ureteroscopy or RIRS
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Percutaneous nephrolithotomy
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Staged or combined procedures for selected complex stones
Each option has advantages and limitations.
1. Observation for Selected Stones
Observation can be reasonable for certain small stones that are not causing significant problems.
The doctor may recommend:
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Periodic imaging
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Pain management when required
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Appropriate fluid intake
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Monitoring for infection or obstruction
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Follow-up assessment
Observation does not mean ignoring the stone.
A stone that grows, becomes symptomatic or causes obstruction may eventually require removal.
2. Medicines and Medical Management
Medicines do not remove every type of kidney stone.
Depending on the stone's location and characteristics, medication may be used to:
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Control pain
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Reduce nausea
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Facilitate passage of selected ureteral stones
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Treat an identified infection
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Prevent recurrence
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Dissolve certain stone types under specialist supervision
Some uric acid stones can potentially be dissolved through medically supervised urine alkalinization.
Most common calcium-based stones cannot simply be dissolved with tablets.
3. Shock Wave Lithotripsy
Shock wave lithotripsy (SWL or ESWL) uses externally generated shock waves to fragment a stone into smaller pieces.
The fragments can then pass through the urinary tract.
SWL may be suitable for selected stones depending on:
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Stone size
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Stone location
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Stone density
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Kidney anatomy
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Patient body habitus
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Urinary drainage
A larger or dense stone may require more than one session.
SWL is less invasive than procedures requiring instruments to enter the urinary tract, but it is not appropriate for every stone.
4. Ureteroscopy With Laser Lithotripsy
Ureteroscopy involves passing a thin endoscope through the urinary passage to reach the stone.
A laser can then break the stone into smaller fragments.
Depending on the situation, fragments may be removed using specialized instruments.
This approach can be used for many ureteral stones and selected kidney stones.
A temporary ureteral stent may be placed after treatment in some patients.
5. RIRS for Kidney Stones
Retrograde intrarenal surgery (RIRS) is a form of flexible ureteroscopy used to reach stones inside the kidney.
A flexible scope is advanced through the urinary tract into the kidney, where the stone can be fragmented with laser energy.
RIRS may be considered when the stone's location and characteristics make this approach appropriate.
For a larger stone burden, treatment may sometimes need to be staged.
6. PCNL for Larger Stones
Percutaneous nephrolithotomy (PCNL) is commonly considered for larger or complex kidney stones.
A small access tract is created through the skin into the kidney.
Specialized instruments are then used to fragment and remove the stone.
PCNL can provide substantial stone clearance for appropriate larger renal stone burdens.
It is a surgical procedure and carries risks such as bleeding, infection and injury to surrounding structures, although the overall risk depends on patient and procedure factors.
Which Kidney Stone Removal Treatment Is Best?
There is no single best procedure for every patient.
For example:
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A small stone may be monitored.
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A suitable stone may respond to SWL.
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A ureteral stone may be treated with ureteroscopy and laser.
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A larger renal stone may be better suited to PCNL.
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A complex stone burden may require staged or combined treatment.
The treatment decision should be based on imaging and specialist assessment rather than choosing a procedure solely because it is described as "laser," "painless" or "non-surgical."
Can Kidney Stones Be Removed Without Surgery?
Some stones can pass naturally without a procedure.
However, the phrase kidney stone removal without surgery can be misleading because there is no reliable home method that physically removes every stone.
For selected small stones, doctors may recommend observation and medical management.
Certain uric acid stones may be dissolved with prescription treatment under medical supervision.
Most larger or obstructing stones require an active procedure if they do not pass or resolve with appropriate management.
Can Drinking More Water Remove a Kidney Stone?
Adequate fluid intake is important for preventing dehydration and may support passage of some small stones.
However, excessive water intake does not reliably remove a large stone.
If a stone is causing obstruction, forcing large amounts of water can increase discomfort without resolving the blockage.
Fluid recommendations should be individualized, particularly for people with reduced kidney function, heart disease or fluid restrictions.
When Is Kidney Stone Removal Urgent?
Not every stone requires emergency treatment, but certain situations need rapid assessment.
Urgent medical attention is particularly important when a suspected or known stone is accompanied by:
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Fever
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Chills
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Severe flank pain
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Persistent vomiting
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Very little or no urine
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Severe weakness
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Confusion
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Worsening kidney function
An infected obstructed urinary tract can be a medical emergency.
In such cases, the immediate priority may be restoring urine drainage, such as through a ureteral stent or nephrostomy, while definitive stone treatment is planned after the infection has been appropriately managed.
What Tests Are Needed Before Stone Removal?
The evaluation depends on the individual patient.
Imaging
Ultrasound or CT imaging may provide information about:
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Stone size
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Location
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Number
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Obstruction
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Kidney anatomy
A non-contrast CT scan is commonly useful when detailed stone assessment is required.
Blood Tests
The doctor may check:
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Creatinine
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eGFR
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Electrolytes
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Hemoglobin
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Other relevant parameters
Urine Tests
Testing may include:
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Urinalysis
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Urine culture when infection is suspected
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Other urine investigations when indicated
Identifying an infection before definitive stone treatment is particularly important.
What Happens on the Day of a Stone Removal Procedure?
The exact process depends on the selected treatment.
Before the procedure, the medical team may review:
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Imaging
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Laboratory results
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Medications
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Allergies
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Medical conditions
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Infection status
Anesthesia or sedation requirements vary between procedures.
After treatment, the patient is monitored for pain, bleeding, urinary problems and other immediate complications.
Some procedures are performed as day-care treatments, while others may require a hospital stay.
Will a Stent Be Needed After Stone Removal?
Not every patient needs a stent.
A ureteral stent may be used when the doctor believes it will support urine drainage or healing.
Reasons can include:
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Ureteral swelling
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Temporary obstruction risk
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Stone fragments
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Ureteral irritation
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More extensive treatment
A stent can cause temporary symptoms such as urinary frequency, urgency or discomfort.
It should be removed or exchanged according to the treating doctor's instructions.
What Is Recovery Like After Kidney Stone Removal?
Recovery depends on the procedure and the patient's health.
Temporary symptoms may include:
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Mild blood in urine
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Burning during urination
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Urinary frequency
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Flank discomfort
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Passage of small fragments
Patients should follow the specialist's instructions regarding:
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Medicines
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Fluid intake
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Physical activity
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Stent care
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Follow-up imaging
Severe pain, fever, chills, inability to urinate or rapidly worsening symptoms should be reported promptly.
Can Kidney Stone Removal Damage the Kidney?
Modern stone procedures are designed to remove stones while minimizing injury to the urinary system.
However, every procedure has potential risks.
The risk depends on:
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Stone size
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Number of stones
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Stone location
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Procedure selected
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Patient anatomy
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Existing kidney disease
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Infection status
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Overall health
Leaving an obstructing stone untreated can also damage kidney function.
The risks and expected benefits should therefore be discussed before choosing treatment.
What Happens if a Stone Is Left Untreated?
The consequences depend on the stone.
A small, non-obstructing stone may remain stable for some time.
A problematic stone can potentially lead to:
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Recurrent pain
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Urinary obstruction
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Recurrent infection
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Hydronephrosis
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Reduced kidney function
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Repeated emergency visits
A specialist can determine whether observation is reasonable or whether removal would be safer.
Can Kidney Stones Come Back After Removal?
Yes.
Stone removal treats the existing stone but does not necessarily remove the reason why the stone formed.
Recurrence may be associated with:
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Inadequate fluid intake
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High dietary sodium
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Certain dietary patterns
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Metabolic abnormalities
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Family history
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Recurrent urinary infections
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Certain medical conditions
This is why prevention should become part of long-term stone care.
How to Reduce the Risk of Future Kidney Stones
Prevention should be tailored to the stone type.
General measures may include:
Maintain Appropriate Fluid Intake
The amount should be individualized according to health status and stone risk.
Limit Excess Sodium
High sodium intake can increase urinary calcium in some people and may contribute to stone formation.
Maintain a Balanced Diet
Extreme dietary restrictions are generally unnecessary unless specifically recommended.
Do Not Unnecessarily Avoid Dietary Calcium
For many calcium-stone patients, normal dietary calcium intake is important and should not be restricted without medical advice.
Consider Stone Analysis
If a removed or passed stone is available, analysis can help identify its composition.
Metabolic Evaluation
People with recurrent or high-risk stones may benefit from additional urine and blood testing to identify factors that can be treated.
Kidney Stone Removal in People With Kidney Disease
Patients who already have reduced kidney function may require additional consideration before stone treatment.
The medical team may review:
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Baseline creatinine
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eGFR
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Electrolytes
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Medications
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Fluid status
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Infection risk
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Degree of obstruction
The objective is to treat the stone while protecting remaining kidney function.
Kidney Stones During Pregnancy
Pregnancy can make the evaluation and treatment of urinary stones more complex.
Imaging choices, pain medicines and procedures need to be selected carefully.
A pregnant patient with severe pain, fever, obstruction or persistent vomiting should receive prompt medical assessment.
Stone management during pregnancy should be coordinated by the appropriate medical team.
Why You Should Not Delay Treatment for an Obstructing Stone
A stone that blocks urine drainage is different from an incidental, non-obstructing stone.
Persistent obstruction can place pressure on the urinary system and may impair kidney function.
The risk becomes more serious if infection develops behind the obstruction.
For this reason, patients should not rely solely on home remedies when imaging has shown significant obstruction.
Kidney Stone Care at Prabhakar Bhurke Clinic
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides specialist evaluation for kidney-function problems associated with urinary stones.
Depending on the patient's condition, care may include:
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Review of creatinine and eGFR
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Assessment of kidney function
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Review of ultrasound or CT findings
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Evaluation of urinary obstruction
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Assessment of infection-related complications
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Medical management of kidney-related complications
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Stone recurrence-risk evaluation
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Coordination with appropriate urological specialists for stone-removal procedures
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Kidney monitoring after stone treatment
The appropriate treatment pathway depends on the stone's characteristics and the patient's overall medical condition.
Frequently Asked Questions About Kidney Stone Removal
What is the best kidney stone removal treatment?
There is no single treatment that is best for every stone. Observation, SWL, ureteroscopy with laser, RIRS and PCNL may all have a role depending on stone size, location, density, obstruction and patient factors.
Can a kidney stone be removed without surgery?
Some small stones can pass naturally with appropriate medical management. Certain uric acid stones may be dissolved medically. Larger, obstructing or problematic stones often require an active removal procedure.
Is laser treatment safe for kidney stones?
Ureteroscopy with laser lithotripsy is an established treatment for appropriately selected stones. As with any procedure, there are potential risks, and suitability depends on the individual patient.
How long does kidney stone removal take?
The duration varies significantly according to the procedure, stone burden, location and complexity. Some treatments may be completed in one session, while larger or complex stones may require staged treatment.
Does kidney stone removal require a stent?
Not always. A stent may be placed when temporary support of urine drainage or ureteral healing is considered beneficial.
Can a kidney stone damage the kidney if it is not removed?
A non-obstructing stone may sometimes remain without causing significant damage, but persistent obstruction, infection or recurrent complications can impair kidney function.
Can kidney stones return after removal?
Yes. Preventive measures and, for selected patients, stone analysis and metabolic evaluation can help reduce recurrence risk.
Conclusion
Choosing the right kidney stone removal treatment depends on the individual stone and the patient rather than on one universally superior procedure.
Small, uncomplicated stones may sometimes be observed, while problematic stones may require SWL, ureteroscopy with laser lithotripsy, RIRS or PCNL. Stone size, location, density, obstruction, infection and kidney function all contribute to treatment planning.
An infected obstructed urinary tract requires urgent medical attention and may need drainage before definitive stone removal.
After the stone has been treated, prevention is equally important. Appropriate fluid intake, dietary measures, stone analysis and metabolic evaluation in selected patients can help reduce the risk of recurrence.
If you have been diagnosed with a kidney stone and are unsure whether you need observation or active removal, specialist evaluation can help determine the safest treatment approach.
For kidney-function assessment and specialist kidney care, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.
Medical Disclaimer
This article is intended for general educational and informational purposes only and should not be considered a substitute for professional medical advice, diagnosis or treatment. Kidney stone removal treatment depends on stone size, location, composition or density, urinary obstruction, infection status, kidney function, anatomy and overall health. Not every patient is suitable for SWL, ureteroscopy, laser treatment, RIRS or PCNL. Do not attempt to force a stone to pass by drinking excessive amounts of water or by taking unprescribed medicines or herbal products. Do not start, stop or change prescription medicines without medical advice. Fever, chills, severe flank pain, persistent vomiting, very little or no urine, confusion or rapidly worsening symptoms may indicate a serious complication requiring urgent medical attention. Consult Dr. Sandip Prabhakar Bhurke or another qualified healthcare professional for an individualized treatment plan.
