A renal stone is a hard deposit of minerals and salts that forms in the kidney or urinary tract. Some small stones pass naturally, but others remain in the kidney, obstruct urine flow, cause repeated pain or contribute to infection.

When observation or medication is unlikely to solve the problem safely, a procedure to break up or remove the stone may be recommended. The decision depends on stone size, location, composition, symptoms, urinary drainage and the patient's overall health.

Surgery is not necessary for every kidney stone. Some asymptomatic stones can be monitored, while others require active treatment because they are growing, causing obstruction, associated with infection or affecting kidney function.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides kidney evaluation and management and can help coordinate appropriate specialist care when a renal stone requires a procedure.

Which Kidney Stone Operation Is Best?

There is no single operation that suits every patient. The main procedures used for stone treatment are compared below.

The choice depends on imaging findings, stone characteristics, anatomy, bleeding risk, infection status and other health conditions. Large renal stones over 2 cm are generally treated with PCNL when appropriate.

1. Laser Surgery for Renal Stones

Laser stone removal is commonly performed through ureteroscopy or retrograde intrarenal surgery (RIRS).

How the Procedure Works

1. The patient receives the planned anaesthesia.

2. A thin endoscope is passed through the urethra and bladder into the ureter or kidney.

3. The doctor locates the stone using the endoscopic view.

4. Laser energy breaks the stone into smaller fragments.

5. Fragments may be removed with a basket or left to pass when appropriate.

6. A temporary ureteral stent may be placed if needed.

Laser ureteroscopy avoids making an incision through the skin to reach the stone. Depending on stone burden and location, more than one session may be necessary.

Benefits and Limitations

Potential benefits include direct visualization of the stone and the ability to treat stones in several urinary tract locations.

Possible limitations include the need for anaesthesia, temporary stent discomfort, residual fragments, infection or ureteral injury. Larger stones may require staged treatment.

2. RIRS for Stones Inside the Kidney

Retrograde intrarenal surgery (RIRS) uses a flexible ureteroscope to access stones within the kidney.

The doctor advances the scope through the urinary tract rather than creating an external access tract. A laser can then fragment the stone.

RIRS may be suitable for selected renal stones, including some that are difficult to access with other techniques. However, stone size, density, anatomy and the expected number of procedures must be considered.

For very large stones, PCNL may provide more effective stone clearance in a single treatment, when suitable.

3. PCNL for Large Renal Stones

Percutaneous nephrolithotomy (PCNL) is a procedure commonly used for large or complex kidney stones.

The surgeon creates a small access tract through the back into the kidney. A viewing instrument and specialized tools are then used to fragment and remove the stone.

PCNL may be recommended when:

• The stone is larger than 2 cm

• The stone burden is extensive

• The stone has a complex configuration

• Other methods are unlikely to clear the stone effectively

• The treating specialist considers the procedure appropriate

PCNL is effective for many large stones, but it carries risks such as bleeding, infection and injury to nearby structures. Hospital observation and recovery requirements vary by case.

4. ESWL: Breaking Stones Without an Incision

Extracorporeal shock wave lithotripsy (ESWL or SWL) uses externally generated shock waves to break a stone into smaller pieces.

The fragments then pass through the urinary tract.

ESWL may be appropriate for selected stones, depending on their size, location, density and the patient's anatomy.

It is less suitable for some hard stones and certain locations. Large stones may require repeated sessions, and fragments can sometimes collect in the ureter and obstruct urine flow.

Although ESWL avoids an incision, it is not guaranteed to remove every stone in one session.

What Tests Are Needed Before Renal Stone Surgery?

Before selecting a procedure, the treating team needs to understand the stone and assess whether surgery can be performed safely.

Imaging

An ultrasound or CT scan may be used to assess:

• Stone size and number

• Exact location

• Stone density when CT is performed

• Urinary obstruction

• Kidney anatomy

• Other urinary tract abnormalities

A CT scan is particularly useful when detailed stone mapping is required.

Urine Tests

Urinalysis and urine culture may be recommended to look for blood or infection.

A urinary infection should be appropriately treated before definitive stone removal. If an infected obstruction is present, urgent drainage may be required before the stone is removed.

Blood Tests

Depending on the clinical situation, tests may include:

• Creatinine and eGFR

• Electrolytes

• Blood count

• Other tests needed for anaesthesia or procedural planning

Medication and Medical History Review

The team should know about blood thinners, allergies, diabetes, heart disease, pregnancy possibility and any previous kidney procedures.

Do not stop blood thinners or other prescribed medicines unless the treating team gives specific instructions.

What Happens If a Kidney Stone Blocks Urine Flow?

A stone can obstruct urine drainage from the kidney. Persistent obstruction can impair kidney function, particularly when both kidneys are affected or the patient has only one functioning kidney.

If obstruction occurs together with infection, fever or anuria, the situation can become a urological emergency.

Urgent treatment may involve draining the kidney with a ureteral stent or nephrostomy tube. Definitive stone removal is generally planned after the infection has been addressed and the patient is stable.

Seek urgent medical care for fever or chills with stone symptoms, very little or no urine, severe persistent pain or repeated vomiting.

Is Kidney Stone Surgery Painful?

Pain and discomfort vary by procedure and individual factors.

During surgery, anaesthesia or sedation is used as appropriate. Afterward, some patients may experience:

• Mild blood in urine

• Burning during urination

• Urinary urgency or frequency

• Flank discomfort

• Temporary discomfort from a ureteral stent

• Pain while passing stone fragments

The care team can recommend appropriate pain relief based on kidney function and other medical conditions. Do not self-prescribe painkillers, particularly if you have chronic kidney disease.

Why Might a Ureteral Stent Be Needed?

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

It may be used after a procedure when there is swelling, a risk of obstruction, residual fragments or another reason to support drainage.

A stent can cause temporary urinary urgency, frequency, discomfort or blood in urine. It should be removed or exchanged according to the treating doctor's schedule.

Contact your healthcare team if you develop fever, worsening pain, difficulty passing urine or other concerning symptoms.

How Long Does Recovery Take After Renal Stone Surgery?

Recovery depends on the procedure, stone burden, whether a stent or drainage tube is present, and the patient's general health.

• ESWL: Often performed as an outpatient procedure, although fragments may take time to pass.

• Ureteroscopy or RIRS: Many patients go home the same day or after a short observation period, depending on their condition.

• PCNL: May require hospital observation and a longer recovery because it involves access through the skin into the kidney.

These are general patterns, not guarantees. Follow the treating team's instructions about activity, medication, wound care, hydration and follow-up appointments.

What Are the Possible Risks of Kidney Stone Surgery?

All procedures have potential risks. These vary with the technique and the patient's health.

Possible complications include:

• Urinary tract infection

• Bleeding

• Pain or discomfort

• Injury to the ureter or kidney

• Temporary obstruction from fragments

• Residual stones

• Need for another procedure

• Anaesthesia-related complications

The doctor should explain the benefits, risks and alternatives specific to the planned procedure before treatment.

Can Kidney Stones Return After Surgery?

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

Stone recurrence may be associated with low fluid intake, high sodium intake, metabolic abnormalities, family history, certain medical conditions or recurrent infections.

After stone removal, the doctor may recommend stone analysis and, particularly for recurrent or high-risk stone formers, a metabolic evaluation.

Prevention may include individualized dietary advice, appropriate fluid intake and prescribed medicines when indicated. Patients with kidney disease or fluid restrictions should not increase fluids without medical advice.

Who Needs Special Assessment Before Surgery?

Additional planning may be needed for people with:

• Reduced kidney function

• A single functioning kidney

• Stones affecting both kidneys

• Diabetes or significant cardiovascular disease

• Bleeding disorders or blood-thinning medicines

• Pregnancy

• Active urinary infection

• Complex urinary tract anatomy

The safest procedure depends on the complete clinical picture, not simply the stone's diameter.

Kidney Stone Evaluation at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides evaluation for kidney-function problems associated with renal stones.

Depending on the patient's needs, care may include:

• Review of creatinine and eGFR

• Assessment of obstruction and kidney function

• Review of ultrasound and CT reports

• Evaluation of urine abnormalities or infection

• Assessment of stone-related complications

• Medical management of associated kidney conditions

• Coordination with an appropriate urologist or stone surgeon

• Follow-up kidney care and recurrence-risk assessment

Stone-removal procedures are selected according to the diagnosis and should be performed by an appropriately qualified surgical specialist.

Frequently Asked Questions

When is surgery needed for a renal stone?

Surgery may be considered when a stone is unlikely to pass, causes persistent pain, grows, obstructs urine flow, is associated with infection or threatens kidney function. Some asymptomatic stones can be monitored.

Which surgery is best for kidney stones?

There is no single best procedure for every patient. ESWL, ureteroscopy with laser, RIRS and PCNL are selected according to stone size, location, density, anatomy and medical history.

Is laser surgery better than ESWL?

Laser ureteroscopy allows the doctor to reach and treat a stone directly, while ESWL breaks stones using external shock waves. Their suitability and success rates vary with the stone and patient. The treating specialist can explain which option fits the individual case.

Is PCNL used for large kidney stones?

Yes. PCNL is generally the preferred first-line procedure for many renal stones larger than 2 cm, when the patient is suitable for it.

Can a kidney stone be removed without an incision?

Some stones can be treated with ESWL or ureteroscopy/RIRS, which do not require a skin incision to reach the stone. However, the best approach depends on the stone's characteristics.

Can I go home on the same day as kidney stone surgery?

Some patients can go home the same day after ESWL or ureteroscopy. PCNL or complicated cases may require a longer stay. The decision depends on recovery and medical needs.

What should I do if I develop fever after a kidney stone procedure?

Contact your treating team urgently. Fever or chills after a stone procedure may indicate infection, which needs prompt assessment—especially if you also have severe pain, vomiting or reduced urine output.

Conclusion

Surgery for renal stone may be recommended when a stone causes ongoing symptoms, obstruction, infection, growth or a risk to kidney function. The available options include ESWL, ureteroscopy with laser, RIRS and PCNL, each with different benefits, limitations and recovery requirements.

A successful treatment plan begins with accurate imaging, urine testing when indicated, kidney-function assessment and an individualized choice of procedure. Follow-up is also important to confirm stone clearance and reduce the chance of recurrence.

For kidney-function assessment and coordinated care related to renal stones, 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 appropriate procedure for a renal stone depends on its size, location, composition, urinary obstruction, infection status, kidney function and the patient's overall health. Not every stone requires surgery, and no procedure is suitable for every patient. Do not start or stop medicines, alter fluid intake or delay urgent care based on this article. Fever or chills with a suspected obstructing stone, very little or no urine, severe persistent pain, repeated vomiting, chest pain or breathlessness require prompt medical assessment. Consult Dr. Sandip Prabhakar Bhurke or another qualified healthcare professional for individualized evaluation and treatment planning.