The treatment options
Watchful waiting with medical expulsive therapy. For small stones with a reasonable chance of passing. Fluids, pain relief, and often tamsulosin to help the ureter relax. Reviewed with repeat imaging.
ESWL (shock wave lithotripsy). Sound waves break the stone from outside the body. No anaesthesia in many cases, no instruments inserted. Works well for smaller, softer stones in favourable positions. Fragments still have to pass, which can take weeks, and a second session is sometimes needed.
URS (ureteroscopy). A thin scope passed up the urinary tract to reach a stone in the ureter, broken with a laser and removed. Day-care, spinal or general anaesthesia. High success rate for ureteric stones.
RIRS (retrograde intrarenal surgery). A flexible scope reaches stones inside the kidney itself, broken with a holmium laser. No cut and no puncture through the skin — access is through the natural urinary passage. Suitable for kidney stones up to around 2 cm, and for patients in whom PCNL carries higher risk.
PCNL (percutaneous nephrolithotomy). For large or staghorn stones. A small tract is made through the flank directly into the kidney. It involves a puncture site and a two to three day stay, but it clears large stone burdens in a single procedure where other methods would need several.
No single technique is best for every stone. Anyone who tells you otherwise is selling a procedure rather than assessing your case.
About stents — read this before your procedure
After URS or RIRS, a ureteric stent is usually placed. This is a soft tube running from the kidney to the bladder that keeps urine draining while swelling settles. It matters because most patients are not told about it in advance:
- It stays in for around one to two weeks
- It can cause a frequent urge to pass urine, some discomfort in the flank when urinating, and small amounts of blood in the urine
- These symptoms are normal, not a complication
- It is removed in a short outpatient procedure
Not everyone needs one, and the decision is made during surgery based on what is found. But you should go in expecting one rather than discovering it afterwards.
Recovery
- URS and RIRS — day-care in most cases, home the same day after a few hours
- PCNL — usually a two to three day stay
- Desk work after a few days; earlier without a stent, longer with one
- Physical work and exercise after around two weeks
- Follow-up imaging to confirm the stone has cleared
Risks
Stone surgery is safe and routine, but no procedure is risk-free. The recognised risks include bleeding, infection, injury to the ureter, and — most importantly — post-operative infection or sepsis, which is why urine is tested and any infection treated before surgery is scheduled.
Occasionally a stone cannot be fully cleared in one session and a second procedure is needed. Your individual risks are discussed before you consent.
Preventing the next one
Around half of people who form a stone will form another within ten years. Prevention is worth taking seriously:
- Drink enough that urine stays pale — usually 2.5 to 3 litres a day
- Reduce salt, which raises the calcium in urine
- Do not cut out dietary calcium; low-calcium diets increase stone risk
- Moderate intake of oxalate-rich foods if you form calcium oxalate stones
- Reduce animal protein if you form uric acid stones
- Citrate, from lemon juice or as potassium citrate, inhibits stone formation
If you have had more than one stone, a metabolic evaluation — blood tests, a 24-hour urine collection, and stone analysis where the stone is retrieved — identifies why you are forming them and what specifically to change.