Urinary stone removal refers to treatment used to eliminate stones that develop anywhere within the urinary system.

Urinary stones can occur in the:

• Kidneys

• Ureters

• Bladder

• Occasionally other parts of the urinary tract

Some small stones may pass naturally without a procedure. Larger stones, stones causing persistent obstruction or stones associated with infection may require active treatment.

The appropriate removal method depends on several factors, including stone size, location, composition or density, symptoms, urinary obstruction, infection and kidney function.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides kidney-function assessment and specialist care for patients with urinary stones and related kidney problems. When a stone requires a procedure, coordination with an appropriate urological specialist may be recommended.

When Does a Urinary Stone Need to Be Removed?

Not every urinary stone needs immediate surgical removal.

A doctor may recommend observation for selected small, uncomplicated stones that have a reasonable chance of passing naturally.

Active stone removal may be considered when there is:

• Persistent or recurrent severe pain

• Urinary obstruction

• Declining kidney function

• Persistent stone-related symptoms

• Recurrent urinary infection

• Increasing stone size

• A stone that is unlikely to pass naturally

• Occupational or lifestyle circumstances where spontaneous passage creates significant problems

• Patient preference after discussing the available options

The decision should be based on imaging and the patient's overall clinical condition.

What Determines the Choice of Stone Removal Procedure?

There is no single procedure suitable for every urinary stone.

The treating team may consider:

Stone Size

Small stones may pass naturally, while larger stones are more likely to require a procedure.

Stone Location

A kidney stone, upper ureteral stone and bladder stone may require different approaches.

Stone Density

CT imaging can provide information about stone density, which may help determine whether shock wave treatment is appropriate.

Urinary Anatomy

The shape and anatomy of the kidney and urinary tract can influence procedural planning.

Infection

An infected obstructed urinary tract requires urgent attention. In such cases, restoring urine drainage may take priority over definitive stone removal.

Kidney Function

Reduced kidney function can affect both treatment planning and medication choices.

Tests Before Urinary Stone Removal

Before deciding on treatment, the doctor may recommend several investigations.

Ultrasound

Ultrasound can identify many urinary stones and may show swelling of the kidney caused by obstruction.

CT Scan

A non-contrast CT scan can provide detailed information about:

• Stone size

• Location

• Number

• Density

• Obstruction

• Urinary anatomy

Urine Testing

Urinalysis may detect:

• Blood

• Infection

• Crystals

• Other abnormalities

A urine culture may be recommended when infection is suspected.

Blood Tests

Depending on the situation, testing may include:

• Serum creatinine

• eGFR

• Electrolytes

• Blood count

• Other relevant investigations

These tests help assess both the stone and the patient's readiness for treatment.

Main Urinary Stone Removal Options

Treatment can involve several approaches.

1. Ureteroscopy With Laser Lithotripsy

Ureteroscopy (URS) is a minimally invasive procedure in which a thin scope is passed through the urinary passage to reach a stone in the ureter or kidney.

Once the stone is visualized, a laser can fragment it into smaller pieces.

Fragments may be removed using a small basket or allowed to pass naturally when appropriate.

Ureteroscopy may be particularly useful when:

• A stone is located in the ureter

• A stone is unsuitable for shock wave treatment

• A higher stone-free rate is desired in selected situations

• A stone has not passed naturally

• Previous treatment has been unsuccessful

A temporary ureteral stent may be placed after the procedure in selected cases.

2. Flexible Ureteroscopy and RIRS

For stones located inside the kidney, a flexible ureteroscope can be advanced into the renal collecting system.

This approach is commonly called retrograde intrarenal surgery (RIRS).

A laser can fragment the stone, and selected fragments can be retrieved.

RIRS may be considered for renal stones based on:

• Stone size

• Location

• Density

• Anatomy

• Previous treatment

• Patient factors

Larger stone burdens may require more than one procedure.

3. ESWL or Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) uses focused shock waves generated outside the body to fragment selected urinary stones.

The fragments can subsequently pass through the urinary tract.

ESWL may be suitable for selected stones depending on:

• Size

• Location

• Density

• Anatomy

• Body habitus

• Degree of obstruction

Some stones may require repeated sessions.

ESWL may be less suitable when a stone is very dense, unusually positioned or associated with certain anatomical or clinical factors.

4. PCNL

Percutaneous nephrolithotomy (PCNL) is generally used for larger or complex kidney stones.

A small access tract is created through the skin into the kidney, allowing instruments to fragment and remove the stone.

PCNL may be considered when the stone burden is substantial or when other techniques are less suitable.

As with other procedures, the choice depends on imaging findings, anatomy, kidney function and overall health.

5. Bladder Stone Removal

Bladder stones are different from kidney and ureteral stones.

Depending on the stone's size and underlying cause, treatment may involve endoscopic removal or fragmentation through the urinary passage.

The reason the bladder stone formed should also be investigated.

Possible contributing factors include:

• Incomplete bladder emptying

• Urinary obstruction

• Certain infections

• Foreign bodies

• Metabolic factors

Simply removing the stone without addressing an underlying urinary problem may allow recurrence.

Can Urinary Stones Be Removed Without Surgery?

Some small urinary stones can pass naturally without an invasive procedure.

Medical management may include:

• Pain relief

• Appropriate fluid intake

• Observation

• Medicines that facilitate passage in selected ureteral stones

However, medicines generally do not dissolve most common urinary stones.

Certain uric acid stones can sometimes be dissolved through medically supervised urine alkalinization.

The stone's composition and clinical circumstances need to be established before considering this approach.

Can Drinking Water Remove a Urinary Stone?

Adequate fluid intake is important for many people with urinary stones and can help increase urine volume.

However, drinking excessive amounts of water does not reliably force a large or obstructing stone out.

If urine flow is blocked, forcing large quantities of fluid can increase discomfort and may worsen fluid-related problems in susceptible patients.

People with reduced kidney function or fluid restrictions should follow individualized medical advice.

What Happens if a Stone Blocks the Urinary Tract?

A urinary stone can obstruct the flow of urine from the kidney to the bladder.

Obstruction may result in:

• Hydronephrosis

• Flank pain

• Reduced kidney function

• Infection

• Recurrent urinary symptoms

Prolonged obstruction can potentially damage the affected kidney.

The degree and duration of obstruction influence the urgency of treatment.

Urinary Stone With Infection: Why It Is Urgent

A blocked urinary tract combined with infection can become a medical emergency.

Warning signs may include:

• Fever

• Chills

• Severe flank pain

• Vomiting

• Burning urination

• Reduced urine output

• Feeling severely unwell

When an infected kidney is obstructed, urgent drainage may be necessary.

A ureteral stent or nephrostomy tube may be used to restore urine drainage. Definitive stone removal is generally performed after the infection has been appropriately addressed, depending on the clinical situation.

Does Every Urinary Stone Cause Pain?

No.

Some stones remain in the kidney and cause few or no symptoms.

Pain is more likely when a stone:

• Moves into the ureter

• Causes obstruction

• Irritates the urinary tract

Other urinary or abdominal conditions can also cause similar pain.

Therefore, imaging and appropriate evaluation are important when symptoms persist.

What Is Recovery Like After Urinary Stone Removal?

Recovery depends on the procedure and the patient's overall health.

After treatment, temporary symptoms may include:

• Mild blood in urine

• Burning while urinating

• Urinary frequency

• Flank discomfort

• Passage of small fragments

Patients who undergo ureteroscopy may have a temporary ureteral stent.

After ESWL, stone fragments may pass over several days or longer depending on the stone burden.

Recovery after PCNL may involve a longer period of observation and activity restrictions compared with some endoscopic procedures.

The treating specialist will provide procedure-specific instructions.

Why Is a Ureteral Stent Sometimes Used?

A ureteral stent is a thin flexible tube placed inside the ureter to help maintain urine drainage.

A stent may be used after stone treatment when:

• The ureter has been irritated or swollen

• There are stone fragments that need to pass

• There is concern about temporary obstruction

• The procedure involved significant manipulation

• Continued drainage is desirable during healing

Stents are generally temporary and should be removed or exchanged according to the planned schedule.

What Are the Possible Risks of Urinary Stone Removal?

The risks depend on the selected procedure.

Possible complications can include:

• Bleeding

• Infection

• Pain

• Residual stone fragments

• Temporary urinary symptoms

• Ureteral injury

• Need for another procedure

• Stent-related discomfort

• Obstruction from stone fragments

Serious complications are uncommon but can occur.

The treating specialist should explain procedure-specific risks before treatment.

Can Urinary Stones Come Back After Removal?

Yes.

Removing a stone treats the existing stone but does not necessarily eliminate the reason it formed.

Recurrence may be associated with:

• Low urine volume

• High sodium intake

• Certain dietary patterns

• Metabolic abnormalities

• Family history

• Recurrent urinary infections

• Certain medical conditions

People with recurrent stones may benefit from stone analysis and metabolic evaluation.

How Can Future Stones Be Prevented?

Prevention depends on stone composition and individual risk factors.

General measures may include:

• Maintaining an appropriate fluid intake

• Reducing excessive dietary sodium

• Following a balanced diet

• Maintaining appropriate dietary calcium

• Avoiding unnecessary supplements

• Treating recurrent urinary infections

• Taking prescribed preventive medicines

• Completing metabolic evaluation when recommended

• Attending follow-up appointments

Dietary changes should be individualized, particularly for people with kidney disease or other medical conditions.

When Should You Seek Emergency Care?

A person with a known urinary stone should seek urgent medical attention if they develop:

• Fever or chills

• Severe or worsening flank pain

• Persistent vomiting

• Very little or no urine

• Severe weakness

• Confusion

• Severe pain with fever

• Rapid deterioration

The combination of infection and urinary obstruction requires particularly urgent evaluation.

Urinary Stone Evaluation at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized kidney evaluation for patients with urinary stones and related kidney-function concerns.

Depending on the patient's condition, assessment may include:

• Review of kidney and urinary symptoms

• Kidney-function testing

• Creatinine and eGFR assessment

• Urine examination and infection evaluation

• Review of ultrasound or CT reports

• Assessment of urinary obstruction

• Evaluation of recurrent stone risk

• Medical management of associated kidney problems

• Coordination with an appropriate urological specialist when procedural stone removal is required

• Follow-up kidney care after stone treatment

The appropriate removal strategy depends on the stone's characteristics, urinary anatomy, infection status, kidney function and overall health.

Frequently Asked Questions

What is the best method for urinary stone removal?

There is no single method suitable for every stone. Observation, ureteroscopy with laser lithotripsy, RIRS, ESWL and PCNL may all have a role depending on the stone's size, location, density, anatomy and clinical circumstances.

Can a urinary stone be removed with laser?

Yes. Ureteroscopy or flexible ureteroscopy can use laser energy to fragment selected kidney and ureteral stones.

Can a urinary stone pass without surgery?

Some small stones can pass naturally. The likelihood depends on stone size and location. Large, obstructing, infected or persistent stones may require active removal.

How long does urinary stone removal take?

The duration varies according to the procedure, stone burden and individual circumstances. Some stones can be treated in one session, while larger or complex stones may require staged treatment.

Is ESWL better than laser treatment?

ESWL and laser-based ureteroscopy are different treatment approaches. Suitability depends on stone size, location, density, anatomy, obstruction and other patient factors.

Is PCNL used for urinary stones?

PCNL is primarily used for larger or complex kidney stone burdens. It is selected according to imaging findings and the patient's individual circumstances.

Can urinary stones damage the kidneys?

Persistent obstruction, recurrent infection or repeated stone-related complications can impair kidney function. Prompt evaluation is important when a stone is causing obstruction or infection.

Can urinary stones return after removal?

Yes. Stone recurrence is possible unless the underlying risk factors are addressed. Stone analysis and metabolic evaluation can help guide prevention in appropriate patients.

Conclusion

Urinary stone removal is not one single procedure. The appropriate treatment depends on where the stone is located, how large or dense it is, whether it is obstructing urine flow, whether infection is present and how well the kidneys are functioning.

Small uncomplicated stones may sometimes pass naturally. When active treatment is necessary, options can include ureteroscopy with laser lithotripsy, RIRS, ESWL or PCNL, depending on the individual situation.

A blocked urinary tract accompanied by infection requires urgent medical assessment, while recurrent stones may warrant a metabolic evaluation to reduce the risk of future episodes.

If you have been diagnosed with a urinary stone or are experiencing recurrent stone-related symptoms, specialist assessment can help determine whether observation, medical treatment or a stone-removal procedure is appropriate.

For kidney-function evaluation and specialized 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. The appropriate urinary stone removal method depends on stone size, location, density or composition, urinary anatomy, obstruction, infection, kidney function and the patient's overall health. Not every patient is suitable for ESWL, ureteroscopy, laser lithotripsy or PCNL, and some patients may require staged or combined treatment. Do not attempt to force a stone to pass by drinking excessive amounts of water or by taking unprescribed medicines or herbal remedies. Fever, chills, severe flank pain, persistent vomiting, very little or no urine or rapidly worsening symptoms may indicate a serious complication requiring urgent medical attention. Consult Dr. Sandip Prabhakar Bhurke or an appropriately qualified urinary stone specialist for an individualized treatment plan.