A urinary stone can form in the kidney and travel into the ureter, the narrow tube that carries urine to the bladder. Some small stones pass naturally, while others remain trapped, obstruct urine flow or cause repeated episodes of pain.

When observation or medication is unlikely to resolve the problem safely, urinary stone surgery may be recommended to remove the stone or break it into smaller fragments.

The decision depends on the stone's size, location, number, density, associated infection, degree of obstruction and the patient's overall health. Not every stone requires an operation, and not every procedure involves a large incision. Many modern treatments use instruments passed through the urinary tract or a small access opening in the skin. NIDDK

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides kidney evaluation and management of kidney-related complications. When a stone-removal procedure is needed, coordination with an appropriately qualified urologist may be part of the patient's care.

What Is the Difference Between Kidney Stone Surgery and Ureter Stone Surgery?

The terms describe procedures used for stones in different parts of the urinary system.

• Kidney stone surgery: Treats stones located within the kidney, including the renal pelvis and calyces.

• Ureter stone surgery: Treats stones lodged in the tube connecting the kidney to the bladder.

• Bladder stone treatment: Addresses stones that form or remain in the bladder.

• Urethral stone treatment: Addresses stones located in the urethra, the passage that carries urine out of the body.

The stone's location matters because it affects which instruments can reach it, how easily fragments can pass and whether urine drainage needs to be restored.

Tests Performed Before Urinary Stone Surgery

Before recommending a procedure, the treating team needs to understand the stone and assess whether it is affecting the urinary tract or kidney function.

Imaging Tests

An ultrasound or CT scan may help establish:

• Exact stone location

• Stone size and number

• Possible obstruction or kidney swelling

• Urinary tract anatomy

• Other stones that may need treatment

A non-contrast CT scan is often useful when detailed information about a urinary stone is needed. The choice of imaging depends on the clinical situation.

Urine Tests

Urinalysis and, when indicated, a urine culture can help identify blood or infection. An infection needs particular attention before definitive stone removal.

Blood Tests

The doctor may assess serum creatinine, eGFR, electrolytes and blood counts, depending on the patient's condition.

Medical and Medication Review

The team may review existing illnesses, previous stone procedures, allergies, blood-thinning medicines and anesthesia-related risks.

These findings help guide the choice and timing of surgery.

Which Urinary Stone Surgery Is Best?

There is no single procedure that is best for every patient. The main options are shock wave lithotripsy, ureteroscopy with or without laser treatment, retrograde intrarenal surgery and percutaneous nephrolithotomy. Current European Association of Urology guidance recommends selecting treatment according to stone characteristics, patient factors and clinical findings.

Common procedures at a glance

1. Shock Wave Lithotripsy (ESWL)

Extracorporeal shock wave lithotripsy (ESWL) breaks a stone into smaller fragments using shock waves generated outside the body.

The fragments then need to pass through the urinary tract.

ESWL may be suitable for selected stones depending on their size, location, density and the patient's anatomy. Some patients require repeat treatment or another procedure if fragments remain.

Potential drawbacks include temporary discomfort, blood in the urine, bruising, incomplete stone clearance and blockage caused by fragments. It is not the best option for every stone, particularly when stone characteristics make fragmentation or fragment passage less favourable.

2. Ureteroscopy With Laser Lithotripsy

Ureteroscopy is commonly used when a stone is located in the ureter.

During the procedure, the urologist passes a narrow endoscope through the urethra and bladder into the ureter. A laser may then fragment the stone, and suitable fragments can be removed using a small retrieval basket.

Depending on the stone's location and complexity, the procedure may be performed as a day case, although some patients need a longer hospital stay or further treatment.

Possible risks include infection, bleeding, ureteral injury, residual fragments and temporary urinary discomfort.

3. RIRS for Stones Inside the Kidney

Retrograde intrarenal surgery (RIRS) uses a flexible ureteroscope to reach stones within the kidney through the natural urinary passage.

The surgeon can inspect different parts of the kidney and use laser energy to fragment accessible stones.

RIRS may be useful for selected renal stones, including some stones that are difficult to reach with other methods. Larger stone burdens may require staged procedures, and a temporary ureteral stent may be needed.

The final choice depends on stone size, position, density, anatomy and the patient's medical condition.

4. PCNL for Large Kidney Stones

Percutaneous nephrolithotomy (PCNL) is an established treatment for large or complex kidney stones.

The surgeon creates a small opening through the skin of the back into the kidney. Special instruments are used to break up and remove the stone.

PCNL is often considered for renal stones larger than 2 cm and for selected complex stone burdens. It may offer substantial stone clearance, but it is more invasive than some endoscopic or shock wave procedures and may require hospital admission.

Possible complications include bleeding, infection, injury to nearby structures and residual stones. The benefits and risks should be discussed with the treating urologist.

Can Urinary Stones Be Removed Without Surgery?

Sometimes.

Small stones may pass naturally if they are not causing dangerous obstruction, infection or uncontrolled symptoms. In selected cases, a doctor may recommend observation, pain management and medication to help a ureteral stone pass.

However, medicines do not reliably eliminate every stone, and most common stones cannot simply be dissolved with tablets. Certain uric acid stones may respond to medically supervised urine alkalinization.

Active removal may be needed when a stone is unlikely to pass, causes persistent pain, obstructs urine flow, grows, contributes to infection or threatens kidney function.

What If a Stone Blocks Urine Flow and Causes Infection?

A urinary stone causing obstruction together with infection can be a medical emergency.

Warning signs include fever, chills, flank pain, vomiting, feeling severely unwell or reduced urine output.

In this situation, the immediate priority may be urgent drainage using a ureteral stent or a nephrostomy tube, together with appropriate infection treatment. Definitive stone removal is generally delayed until the infection has been adequately managed.

Do not wait for a routine appointment if you have a known obstructing stone and develop fever or chills.

Is Urinary Stone Surgery Painful?

The procedure itself is usually performed with appropriate anesthesia or pain control.

Afterward, the level of discomfort depends on the type of procedure, stone burden and whether a ureteral stent has been placed.

Some patients experience temporary:

• Burning during urination

• Mild blood in the urine

• Urinary urgency or frequency

• Flank discomfort

• Pain while passing small fragments

Your treating team can explain what is expected after your particular procedure and which pain-relief medicines are appropriate. Patients with kidney impairment should not independently take anti-inflammatory painkillers because some can worsen kidney function in susceptible people.

Why Might a Ureteral Stent Be Needed?

A ureteral stent is a thin, flexible tube placed between the kidney and bladder to help urine drain.

It may be used after stone treatment if the ureter is swollen, fragments need to pass or the doctor wants to maintain drainage during recovery.

A stent can cause urinary urgency, frequency, discomfort or blood in the urine. It is usually temporary and must be removed or exchanged according to the treatment plan.

Before leaving the hospital, confirm the planned stent-removal date and how to arrange follow-up.

Recovery After Urinary Stone Surgery

Recovery varies by procedure and by the patient's health.

Some people return home on the same day after ureteroscopy or ESWL, while PCNL and more complex cases may require hospital observation. The treating team will provide individualized instructions.

Recovery guidance may include:

• Take prescribed medicines as directed.

• Follow the recommended fluid plan.

• Avoid strenuous activity for as long as advised.

• Watch for fever, worsening pain or changes in urine output.

• Attend follow-up appointments.

• Complete any planned stent removal.

• Obtain follow-up imaging if recommended.

Do not force excessive fluid intake, particularly if you have kidney disease, heart failure or a prescribed fluid restriction.

What Are the Risks of Urinary Stone Surgery?

All procedures have potential risks. These vary with the technique, stone characteristics, infection status and the patient's overall health.

Possible complications include:

• Urinary tract infection

• Bleeding

• Pain or urinary irritation

• Injury to the ureter or kidney

• Residual stone fragments

• Temporary urinary obstruction

• Stent-related symptoms

• Need for another procedure

• Anesthesia-related complications

Your surgeon should explain the risks that are most relevant to your situation and the likelihood of complete stone clearance.

Can Kidney Stones Return After Surgery?

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

Prevention may include stone analysis, blood tests and, for selected patients with recurrent or high-risk stones, a 24-hour urine evaluation.

Depending on the stone type and results, your clinician may recommend:

• Appropriate daily fluid intake

• Reducing excess dietary sodium

• An individualized eating plan

• Treatment of specific metabolic abnormalities

• Preventive medication when indicated

• Follow-up imaging or laboratory testing

People with chronic kidney disease or other medical conditions should receive individualized dietary and fluid advice rather than following restrictive plans found online.

Kidney Evaluation and Stone-Related Care at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides evaluation and management of kidney-related conditions associated with urinary stones.

Depending on the clinical situation, care may include:

• Reviewing kidney-function results

• Assessing creatinine and eGFR

• Evaluating obstruction-related kidney problems

• Reviewing urine and imaging reports

• Managing associated kidney disease

• Assessing stone-related complications

• Coordinating with a urologist for procedural treatment

• Planning kidney-function monitoring after treatment

• Evaluating recurrence risks and preventive care

Stone-removal procedures are selected according to the diagnosis and may require care from a qualified urologist. The goal is to address the stone safely while protecting kidney function and reducing the risk of future complications.

Frequently Asked Questions

What is the best surgery for urinary stones?

The best procedure depends on stone size, location, density, anatomy, infection status and the patient's health. Options include ESWL, ureteroscopy with laser lithotripsy, RIRS and PCNL.

Is urinary stone surgery always necessary?

No. Some small stones pass naturally and can be monitored. Surgery or another active procedure may be recommended for stones that obstruct urine, cause persistent pain, are unlikely to pass or threaten kidney function.

How long does urinary stone surgery take?

The duration depends on the procedure, stone burden and complexity. Your treating surgeon can provide an estimate after reviewing the imaging and clinical findings.

Can urinary stones be removed with laser treatment?

Yes. Laser lithotripsy is commonly used during ureteroscopy or RIRS to fragment stones that can be reached with an endoscope.

Will I need a stent after stone surgery?

Not everyone needs a stent. It may be placed when drainage needs support or when the ureter is swollen or irritated. If one is inserted, confirm when and where it should be removed.

Is blood in the urine normal after stone surgery?

A small amount of blood may occur temporarily after some procedures. Heavy bleeding, clots, inability to urinate, worsening pain or bleeding accompanied by fever needs prompt medical assessment.

Can a urinary stone damage the kidneys?

A stone may impair kidney function if it causes significant or prolonged obstruction, recurrent infection or other complications. Prompt assessment is particularly important when urine flow is blocked.

Which doctor treats urinary stones?

A urologist commonly performs stone-removal procedures. A nephrologist evaluates kidney function and related medical conditions. Some patients benefit from coordinated care between both specialists.

Conclusion

Urinary stone surgery includes several treatment approaches, from shock wave fragmentation to endoscopic laser removal and PCNL. The right option depends on where the stone is located, how large it is, whether it blocks urine flow and the patient's overall medical condition.

Not every urinary stone requires an operation, but persistent obstruction, severe symptoms, recurrent infection or risk to kidney function may make active treatment necessary. An infected, obstructed urinary tract requires urgent medical attention.

If you have been diagnosed with a kidney or ureteral stone, discuss the available options with a qualified urologist and ensure that your kidney function and other health conditions are considered in the treatment plan.

For kidney-function evaluation and related kidney care, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is for general educational and informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. The choice of urinary stone procedure depends on stone size, location, composition, anatomy, infection status, kidney function and individual health factors. Not every patient is suitable for ESWL, ureteroscopy, laser lithotripsy or PCNL. Do not start medicines, change prescribed treatment or attempt to force a stone to pass without appropriate medical advice. Fever or chills with a suspected obstructing stone, very little or no urine, severe uncontrolled pain, persistent vomiting, confusion or sudden deterioration may indicate a serious complication requiring urgent medical attention. Consult a qualified urologist for stone-removal planning and Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for individualized kidney care.