There is no single treatment that is the best solution for kidney stones in every patient.

The appropriate approach depends on several factors, including:

• Stone size

• Stone location

• Number of stones

• Stone composition or density

• Symptoms

• Urinary obstruction

• Infection

• Kidney function

• Overall health

• Previous history of kidney stones

A small stone that is likely to pass naturally may need observation and symptom management, while a larger or obstructing stone may require a procedure to break or remove it.

Therefore, the goal is not simply to find the strongest treatment. The goal is to choose the safest and most effective option for the particular stone and patient.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides specialist evaluation of kidney function and kidney-related conditions and can help coordinate appropriate management when kidney stones are associated with renal complications.

First Question: Does the Stone Need to Be Removed?

Not every kidney stone requires immediate surgery.

Some smaller stones may pass through the urinary tract without a procedure. Depending on the clinical situation, a doctor may recommend observation, pain management and appropriate fluid intake while monitoring the patient.

Active treatment becomes more important when a stone:

• Is unlikely to pass

• Causes persistent or severe pain

• Blocks urine flow

• Causes recurrent infection

• Is associated with declining kidney function

• Continues to grow

• Causes repeated urinary complications

The decision should be based on imaging and clinical assessment rather than stone size alone.

Best Solution for a Small Kidney Stone

A small stone may sometimes be managed conservatively.

Depending on its size and location, the treatment plan can include:

Observation

If the stone has a reasonable chance of passing and there are no serious complications, the doctor may recommend monitoring.

Pain Management

Kidney stones can cause renal colic when they move through the urinary tract. Appropriate pain medication may be prescribed according to the patient's health and kidney function.

Appropriate Fluid Intake

Adequate hydration can support urine flow and may help some small stones pass.

However, drinking excessive quantities of water does not guarantee that a stone will pass and may be inappropriate for people with kidney failure, significant obstruction or certain heart conditions.

Medical Expulsive Therapy

For selected ureteral stones, a doctor may consider medicines intended to facilitate stone passage.

Such treatment is not appropriate for every stone and should be selected according to its location, size and the patient's condition.

When Is Kidney Stone Surgery the Better Solution?

A procedure may be recommended when spontaneous passage is unlikely or when the stone is causing complications.

Larger stones, stones causing urinary blockage and stones producing significant pain may require active treatment.

Depending on the situation, procedures may include:

• Shock wave lithotripsy

• Ureteroscopy

• Laser lithotripsy

• Percutaneous nephrolithotomy

• Other staged or combined approaches

The treating specialist chooses the procedure after reviewing imaging and other clinical information.

Laser Treatment for Kidney Stones

Laser lithotripsy is commonly performed during ureteroscopy.

A thin ureteroscope is introduced through the urinary tract to reach the stone. Laser energy can then fragment the stone into smaller pieces, which may be removed with specialized instruments or allowed to pass when appropriate.

Ureteroscopy can be used to diagnose and treat stones located in the ureter or kidney.

Laser treatment may be considered when:

• The stone is unlikely to pass

• The stone is causing symptoms

• The location is suitable for ureteroscopic treatment

• A stone needs direct fragmentation or removal

• Previous treatment has not completely cleared the stone

A temporary ureteral stent may sometimes be placed after the procedure to support urine drainage while the urinary tract recovers.

Is PCNL the Best Solution for a Large Kidney Stone?

For larger or complex kidney stones, percutaneous nephrolithotomy (PCNL) may be considered.

During PCNL, a small access tract is created through the back into the kidney. A nephroscope is then used to locate and remove or fragment the stone.

PCNL is particularly useful for larger stone burdens because the stone can be accessed directly rather than relying entirely on fragments passing through the urinary tract.

However, PCNL is not automatically the best option for every large stone.

The decision depends on:

• Total stone burden

• Location

• Kidney anatomy

• Stone density

• Infection status

• Previous procedures

• Patient health

Can ESWL Be the Best Solution?

Extracorporeal shock wave lithotripsy (ESWL or SWL) breaks a kidney stone into smaller fragments using externally generated shock waves.

The fragments may subsequently pass through the urinary tract.

ESWL may be appropriate for selected stones, but its effectiveness can vary according to:

• Stone size

• Stone location

• Stone composition

• Stone density

• Patient anatomy

• Skin-to-stone distance

• Urinary drainage

Some patients may need more than one treatment session or additional treatment if significant residual fragments remain.

Can Kidney Stones Be Treated Without Surgery?

Sometimes.

A smaller, uncomplicated stone may pass naturally without an invasive procedure.

Non-surgical management may involve:

• Observation

• Pain control

• Appropriate fluid intake

• Selected medicines

• Follow-up imaging

However, “treatment without surgery” is not appropriate for every stone.

A large stone, persistent obstruction, severe infection or worsening kidney function may require active intervention.

Trying to delay necessary treatment solely to avoid surgery can sometimes increase the risk of complications.

Can Medicine Dissolve Kidney Stones?

Most kidney stones cannot simply be dissolved with a standard tablet.

Treatment depends on the stone's chemical composition.

Certain uric acid stones, for example, may respond to medically supervised urine alkalinization. Other stone types generally require a different approach.

After a stone is passed or removed, stone analysis can help identify its composition and guide future prevention. A doctor may also recommend metabolic testing, including urine evaluation, in appropriate patients.

Do not take stone-dissolving medicines without confirming the stone type and receiving medical advice.

Does Drinking More Water Remove Kidney Stones?

Water is important for kidney stone prevention and may support passage of some smaller stones.

However, more water is not always a better treatment.

If a stone is lodged in the urinary tract and causing significant obstruction, drinking large quantities of water does not physically remove the blockage.

People with advanced kidney disease, kidney failure, heart disease or fluid restrictions may need a carefully individualized fluid plan.

Therefore, fluid intake should be based on medical advice rather than an attempt to force a stone out.

What Is the Best Treatment for a Kidney Stone in the Ureter?

A ureteral stone may cause severe, wave-like pain as it moves toward the bladder.

The treatment depends on:

• Stone diameter

• Exact ureteral location

• Likelihood of spontaneous passage

• Degree of obstruction

• Pain control

• Infection

• Kidney function

Some smaller ureteral stones can be observed under medical supervision.

If the stone does not pass, continues to cause significant symptoms or creates obstruction, a procedure such as ureteroscopy may be recommended. During ureteroscopy, the stone can be removed or fragmented, often using laser energy.

What Is the Best Treatment for a Kidney Stone in the Kidney?

A stone that remains inside the kidney may behave differently from a stone that has entered the ureter.

The management can range from observation to active stone removal.

The decision depends on:

• Stone size

• Kidney location

• Stone growth

• Symptoms

• Infection

• Obstruction

• Kidney function

• Patient preference and overall health

Possible procedures include SWL, ureteroscopy with laser treatment and PCNL in selected cases.

When Is a Kidney Stone an Emergency?

A kidney stone requires urgent assessment when it is associated with signs of serious obstruction or infection.

Seek prompt medical attention for:

• Fever or chills

• Severe or worsening flank pain

• Persistent vomiting

• Very little or no urine

• Severe weakness

• Confusion

• Significant urinary obstruction

• Rapid deterioration in health

A blocked urinary tract with infection can become a serious medical condition and may require urgent drainage before definitive stone removal.

Do not attempt to manage such a situation at home with water or painkillers alone.

Kidney Stones and Reduced Kidney Function

A stone does not always damage kidney function.

However, prolonged obstruction, recurrent infections or complicated stone disease can affect the kidneys.

People with kidney stones and abnormal creatinine or eGFR may need additional evaluation.

The doctor may assess:

• Serum creatinine

• eGFR

• Electrolytes

• Urine examination

• Urine culture when infection is suspected

• Ultrasound

• CT imaging when clinically appropriate

The objective is to determine whether the stone is affecting urine drainage or kidney function.

How Is the Right Kidney Stone Treatment Chosen?

A useful way to approach kidney stone treatment is to answer several questions.

1. Where Is the Stone?

A kidney stone, upper ureteral stone and lower ureteral stone may have different treatment options.

2. How Large Is It?

Size strongly influences the likelihood of spontaneous passage and the need for a procedure.

3. Is Urine Flow Blocked?

Obstruction can change the urgency and treatment strategy.

4. Is There an Infection?

An infected obstructed urinary system requires urgent medical management.

5. What Is the Stone Made Of?

Stone composition can influence prevention and, in selected cases, medical treatment.

6. How Well Are the Kidneys Working?

Creatinine and eGFR help determine whether kidney function is affected.

7. Has the Stone Caused Problems Before?

Recurrent stones may require a broader preventive evaluation rather than repeated treatment of individual stones alone.

Tests Used Before Choosing Kidney Stone Treatment

The doctor may recommend several investigations.

Ultrasound

Ultrasound can help identify stones, kidney swelling and urinary obstruction.

CT Scan

Non-contrast CT can provide detailed information about stone size, location and the urinary tract.

Urine Testing

Urinalysis can identify blood, crystals and other abnormalities. A urine culture may be needed when infection is suspected.

Blood Tests

Depending on the situation, testing may include:

• Creatinine

• eGFR

• Urea

• Sodium

• Potassium

• Calcium

• Uric acid

• Blood count

These investigations help create a safer treatment plan.

What Happens After Kidney Stone Removal?

Stone removal is not necessarily the end of kidney stone care.

The removed stone or fragments may be sent for laboratory analysis to determine their composition. In selected patients, a 24-hour urine evaluation can help identify factors that increase the risk of future stones.

Follow-up may include:

• Imaging

• Kidney-function testing

• Stone analysis

• Metabolic evaluation

• Dietary advice

• Preventive medicines when indicated

This approach can reduce the likelihood of repeatedly developing new stones.

How Can You Prevent Kidney Stones From Coming Back?

Prevention should be individualized according to the type of stone.

General measures may include:

• Maintain appropriate fluid intake.

• Reduce excessive dietary sodium.

• Follow a balanced diet.

• Take prescribed preventive medicines correctly.

• Treat recurrent urinary infections when present.

• Complete recommended metabolic testing.

• Avoid unnecessary supplements.

• Attend follow-up appointments.

Adequate fluid intake is an important component of preventing many types of kidney stones because it helps dilute urine.

People with kidney failure or fluid restrictions should follow their nephrologist's specific fluid recommendations rather than applying a standard water target.

Is There One Best Solution for Every Kidney Stone?

No.

The “best” treatment is the one that provides appropriate stone clearance or safe observation while minimizing unnecessary risk.

For one patient, observation may be appropriate.

For another, ureteroscopy and laser lithotripsy may offer a suitable route to stone removal.

For a patient with a large renal stone, PCNL may be considered.

In selected cases, ESWL may be appropriate.

Therefore, treatment should be selected after reviewing the complete clinical and imaging picture.

Kidney Stone Care 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 kidney stones and associated kidney-function concerns.

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

• Review of kidney stone history

• Assessment of creatinine and eGFR

• Evaluation of urinary obstruction

• Review of ultrasound or CT reports

• Assessment of recurrent urinary infections

• Kidney-function monitoring

• Evaluation of stone-related complications

• Guidance regarding prevention and recurrence risk

• Coordination with appropriate urological specialists when a stone-removal procedure is required

The appropriate treatment pathway depends on the stone's characteristics and the patient's overall medical condition.

Frequently Asked Questions

What is the best solution for kidney stones?

There is no single best treatment for every stone. Small uncomplicated stones may sometimes pass naturally, while larger, obstructing or painful stones may require SWL, ureteroscopy with laser treatment, PCNL or another procedure.

Can kidney stones go away without surgery?

Yes, some smaller stones can pass naturally. However, the likelihood depends on the stone's size, location and clinical circumstances.

What is the best medicine for kidney stones?

There is no universal kidney stone medicine. Medicines may be used for pain, selected stone-passage situations or prevention depending on the stone type and patient.

Is laser treatment better than ESWL?

Neither is universally better. The appropriate choice depends on stone size, location, composition, anatomy and other clinical factors.

When is PCNL recommended?

PCNL may be considered for larger or complex kidney stones. The final decision depends on stone burden, location, anatomy and the patient's medical condition.

Can drinking water remove a kidney stone?

Adequate fluid intake may help some smaller stones pass, but excessive water does not guarantee stone removal and can be unsafe for some patients.

Can kidney stones damage the kidneys?

A kidney stone can cause kidney problems if it produces persistent obstruction, recurrent infection or other complications. Prompt assessment is particularly important when urine flow is blocked.

How can I stop kidney stones from coming back?

Stone analysis, appropriate fluid intake, dietary adjustments, metabolic evaluation and preventive medicines when indicated can help reduce recurrence risk.

Conclusion

Finding the best solution for kidney stones requires more than choosing a particular medicine or procedure.

A small stone that is likely to pass may be managed conservatively, while a larger, obstructing or persistently painful stone may require active removal. Depending on the circumstances, treatment can include SWL, ureteroscopy with laser lithotripsy, PCNL or another individualized approach.

The stone's size, location, composition, urinary obstruction, infection status and kidney function all influence the treatment decision.

After the immediate stone problem is addressed, identifying why stones formed and taking preventive measures can help reduce recurrence.

For individualized evaluation of kidney stones and associated kidney-function concerns, 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 medical diagnosis, treatment or individualized medical advice. There is no single treatment that is the best solution for every kidney stone. Treatment depends on stone size, location, composition, symptoms, obstruction, infection, kidney function and overall health. Do not attempt to force a stone to pass by drinking excessive amounts of water, and do not take unprescribed medicines or herbal remedies for stone dissolution or pain. Fever, chills, severe or worsening pain, persistent vomiting, very little or no urine, confusion or sudden deterioration may indicate a serious complication requiring urgent medical attention. Consult Dr. Sandip Prabhakar Bhurke or an appropriately qualified kidney or urinary-stone specialist for an individualized treatment plan.