Kidney Stone Removal
Treatments include: lithotripsy, ureteroscopy, or percutaneous nephrolithotomy (PCNL), depending on the size and location of the stone
Kidney stone removal surgery is a safe and effective way to relieve pain, clear blocked urine flow, and remove stones that are too large or complex to pass on their own.
What are kidney stones?
Kidney stones are hard deposits that form when minerals and salts in the urine crystallise. They can develop from a range of substances, including calcium and uric acid, especially when these become too concentrated. Stone formation occurs when the chemical balance in the urine is disrupted, allowing crystals to grow and clump together in the kidneys. These stones can block the flow of urine through the urinary tract, leading to pain and other symptoms.
There are several types of kidney stones, including calcium stones, uric acid stones, struvite stones, and, less commonly, cystine stones. Each type of stone has a different cause and may require specific treatment or prevention strategies.
Symptoms
Common symptoms of kidney stones include severe pain in the side and back, below the ribs, and pain that radiates to the lower abdomen and groin. The pain often comes in waves and fluctuates in intensity. Pain or discomfort when passing urine is also a common symptom. You may notice changes in urine colour or frequency, and blood in the urine (haematuria) can occur, making the urine appear pink, red, or brown. Other symptoms may include nausea, vomiting, and a persistent need to urinate.
Causes and risk factors
Kidney stones develop when certain substances in the urine, such as calcium, oxalate, and uric acid, become concentrated and form crystals. High blood uric acid levels can increase the risk of uric acid stones.
Struvite stones are often associated with urinary tract infections and can recur if infections persist.
Stone formation is influenced by factors such as diet, hydration, and metabolic processes. High levels of calcium in the urine (hypercalciuria) are a significant risk factor for kidney stones, though certain conditions that raise blood calcium can also contribute. The body’s anatomy, including the kidneys and urinary tract, plays a significant role in determining your individual risk. If left untreated, kidney stones can lead to complications such as infection or kidney damage, especially if they cause prolonged blockage.
Treatment options for kidney stones
The treatment for kidney stones depends on their size, location, and composition. Many small stones (usually under 5mm) can pass naturally through the urinary tract without surgery. In these cases, staying well-hydrated by drinking around 2.5 to 3 litres of water daily can help flush the stone out and reduce the risk of new stones forming. Your doctor may also prescribe pain relief medication, such as anti-inflammatory tablets, to ease discomfort while the stone passes naturally. This process can take several days to a few weeks.
However, larger stones (typically>6–8 mm) or those causing severe pain, infection, or blockage often require further treatment. In these cases, your urologist may recommend one of several minimally invasive procedures designed to break up or remove the stone while relieving symptoms.
The main treatment options include:
Shock Wave Lithotripsy (SWL)
A non-invasive treatment that uses focused sound waves to break the stone into smaller pieces that can pass naturally through the urine. The procedure usually lasts 30-60 minutes and doesn’t require any surgical incisions. It is most suitable for stones in the kidney and some stones in the upper ureter, particularly those under about 2cm in size and of suitable density and location.
Ureteroscopy
A thin, flexible scope with a tiny camera is passed through the bladder into the ureter, allowing the urologist to see and remove the stone directly or break it apart with a laser. This is one of the most common procedures for stones trapped in the ureter. It’s usually performed under anaesthesia, and patients can go home the same day. Some mild discomfort or stinging during urination is normal for a few days afterwards. A temporary ureteric stent may be placed to help drainage; this can cause some bladder irritation or discomfort until it is removed.
Surgical method – percutaneous nephrolithotomy (PCNL)
For larger or more complex stones that can’t be treated with other methods, PCNL may be recommended. In this procedure, the surgeon makes a small incision in your back to access the kidney directly and remove the stone.
Your specialist will discuss which treatment is most appropriate based on your individual situation, taking into account the size and position of your stone and your overall health. The goal is to remove the stone completely, relieve symptoms, and prevent future recurrences, helping you get back to everyday life as quickly and safely as possible.
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Ways to payBefore treatment
After your initial consultation, if your urologist has determined that surgery is the best option for your specific case, you will undergo several assessments to ensure you are ready for the procedure. A CT scan or X-rays may be performed to assess the size and position of the stones with precision. Your urologist will review these imaging results to plan the best surgical approach for your specific case. Your medical team will guide you through preoperative instructions and answer any questions you may have.
During treatment
Kidney stone removal procedures are usually carried out under general anaesthesia, although shock wave lithotripsy may sometimes be performed with sedation or strong pain relief instead. The specific steps of the procedure depend on the type of treatment recommended for you and the size and location of your stone.
For shock wave lithotripsy (SWL), no incisions are needed. You will lie on a specialised treatment table while focused sound waves are directed from outside the body toward the stone. These high-energy waves break the stone into smaller fragments, which can then pass naturally through the urine over the following days or weeks.
During ureteroscopy, a very thin, flexible tube with a miniature camera (ureteroscope) is gently inserted through the urethra and bladder to reach the stone. Once located, the stone may be either removed in one piece or broken down into smaller fragments using a laser. The surgeon can then extract the pieces with tiny instruments. This technique is particularly useful for stones in the ureter. Stones in the bladder are usually treated with a different procedure called cystolitholapaxy.
For larger or more complex stones, your specialist may perform a percutaneous nephrolithotomy (PCNL). In this procedure, a small incision (around 1 cm) is made in the lower back, allowing a fine tube to be placed directly into the kidney. Using this access, the surgeon can visualise and remove the stone or break it into smaller pieces with special instruments. In some cases, a small, temporary drainage tube (a nephrostomy tube) may be left in place to help urine drain and aid recovery.
All of these procedures are designed to be as minimally invasive as possible, reducing recovery time and minimising the risk of complications. Your healthcare team will discuss what to expect and provide full aftercare instructions to support a smooth recovery.
After treatment
After kidney stone surgery, your recovery will depend on the type of procedure performed. Your doctor may prescribe pain medication to help manage discomfort, especially if you experience pain when passing urine, which is common during the initial recovery period.
Most patients can resume normal activities within a few days after procedures such as ureteroscopy or SWL, whereas recovery after PCNL may take longer. During this period, it is essential to drink plenty of fluids, including citrus drinks, to help flush out stone fragments, unless your doctor has advised a fluid restriction. These fragments may be passed in the urine, so maintaining good urine flow is essential for recovery and to prevent further complications.
Your medical team will monitor your progress, provide follow-up care, and ensure that your recovery is on track. Always follow their instructions and attend all scheduled appointments to ensure a smooth, successful recovery.
Risks and complications
While kidney stone removal procedures are typically safe and straightforward, it’s essential to be aware of potential complications. Infection and bleeding are the most common risks, and other possible complications include injury to the ureter or kidney, residual stone fragments, or temporary discomfort from a ureteric stent if one is used. In some instances, your surgeon may need to recommend additional surgical intervention to address complications or to remove any remaining stone fragments if initial treatments are unable to clear them completely.
It’s essential to follow your doctor’s instructions closely, including adhering to specific dietary recommendations and maintaining proper fluid intake. Attending all your follow-up visits is particularly important to ensure your recovery remains on track and to catch potential issues early, before they become more serious complications.
If you develop fever, chills, worsening pain, difficulty passing urine, or any other concerning symptoms, contact your doctor promptly to prevent complications and support your long-term kidney health and overall well-being.
Appointment and Treatment Plan
Initial Consultation
You’ll meet with your urologist to discuss your symptoms, review your medical history, and go through any previous scans or tests. If surgery is appropriate, your urologist will explain the recommended options and what to expect.
Pre-Surgery Assessment
Your urologist arranges imaging such as a CT scan or X-ray to measure the size and pinpoint the exact location of your stones. These results are used to plan the most suitable procedure for your case. Your medical team will guide you through pre-operative instructions and answer any questions.
Anaesthesia & Procedure Setup
Most kidney stone procedures are performed under general anaesthesia, though shock wave lithotripsy (SWL) may use sedation or strong pain relief instead.
Surgical Procedure
Kidney stone removal is usually done under general anaesthesia. Depending on your stone, treatment may involve:
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Shock Wave Lithotripsy (SWL): External sound waves break the stone into fragments that pass naturally.
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Ureteroscopy: A thin scope is passed through the urinary tract to remove the stone or break it with a laser.
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PCNL: A small incision in the back allows direct access to the kidney to remove larger or complex stones.
Immediate Recovery
After surgery, you may feel some discomfort, particularly when passing urine. Pain relief will be provided as needed. Most patients recover within a few days after SWL or ureteroscopy, while recovery after PCNL may take longer.
You’ll usually be advised to drink plenty of fluids, often including citrus drinks, to help flush out stone fragments, unless your doctor has advised a fluid restriction. Keeping your urine flowing well supports recovery and helps prevent further problems.
Follow-Up & Monitoring
Your medical team will arrange follow-up appointments to check your progress, review any imaging, and ensure no significant stone fragments remain. Attending these visits is important for long-term kidney health.
When to Seek Help
Contact your doctor immediately if you develop fever, chills, worsening pain, difficulty passing urine, or any new concerning symptoms, as these may be signs of infection or complications.
Experts
We are proud to provide patients with access to a wide range of clinicians, chosen specifically for their knowledge and reputation in their area of expertise. Our experts align with our values: putting you at the centre of your care and educating you on your options at each step of the journey. We encourage you to learn more about our clinicians and how they can help you below. As always, please contact our patient services team if you require any additional information.
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FAQs
Kidney stone removal surgery varies in complexity depending on the stone’s size, location, and type. Many procedures, such as shock wave lithotripsy and ureteroscopy, are minimally invasive and considered outpatient treatments, allowing most patients to return home the same day. These surgeries generally involve lower risk and quicker recovery times than traditional open surgery. However, for larger or more complicated stones, procedures like percutaneous nephrolithotomy may require a small incision, making them more involved but still less invasive than open surgery. Overall, while the term “major surgery” can apply to some kidney stone removal procedures, many modern techniques are designed to minimise patient discomfort and recovery time.
Recovery time after kidney stone removal depends on the type of procedure performed and the patient’s overall health. Minimally invasive procedures like shock wave lithotripsy and ureteroscopy often allow patients to resume normal activities within a few days to a week. In contrast, more invasive surgeries such as percutaneous nephrolithotomy may require a recovery period of several weeks. During recovery, patients are usually advised to maintain adequate fluid intake to help flush out any remaining stone fragments and prevent new stone formation. Pain management and follow-up visits with the healthcare team are essential for monitoring healing and addressing any complications.
Pain experienced during and after kidney stone removal surgery varies depending on the procedure and individual pain tolerance. Procedures like shock wave lithotripsy are generally well-tolerated with minimal discomfort, while ureteroscopy may cause some temporary irritation or burning during urination after the surgery. More invasive surgeries, such as percutaneous nephrolithotomy, can result in more significant post-operative pain due to the small incision and manipulation of kidney tissue. Your doctor will prescribe pain medication to manage discomfort during recovery and will guide you on what to expect. Effective pain management is a key part of post-surgical care to ensure a smoother recovery.
Several surgical options exist for kidney stone removal, chosen based on stone size, location, and patient factors. Shock wave lithotripsy uses focused sound waves to break stones into smaller fragments that can pass naturally through the urinary tract. Ureteroscopy involves inserting a small, flexible tube with a camera through the urinary tract to directly visualise and remove or break up stones using laser technology. Percutaneous nephrolithotomy is a more invasive procedure that involves making a small incision in the back to access and remove larger or complex stones directly from the kidney. These surgical interventions aim to relieve symptoms, restore normal urine flow, and prevent complications such as infection or kidney damage. Your urologist will determine the most appropriate operation tailored to your specific condition.