Kidney stones are solid deposits that form in the kidneys and can cause significant pain. The right treatment depends on the stone’s size, location, and composition — there is a range of stone treatment options.
Outpatient, day case or inpatient, depending on the procedure
ESWL
Ureteroscopy (URS)
PCNL
01
Extracorporeal shockwave lithotripsy (ESWL)
ESWL uses focused sound waves (shockwaves) generated outside the body to break up kidney stones into small fragments, which then pass naturally in the urine over the following days to weeks. No anaesthetic or incision is required. The treatment is delivered while you lie on a padded table, and the stone is targeted using X-ray or ultrasound imaging.
ESWL is most effective for smaller stones (under 2 cm) located in the kidney or upper ureter that have a composition suitable for fragmentation. It may need to be repeated to achieve complete clearance.
02
Before your procedure
No anaesthetic is required — you can eat and drink as normal before ESWL.
Blood-thinning medications must be stopped before the procedure. Specific instructions will be provided.
ESWL cannot be performed during pregnancy, in patients with aortic or renal aneurysms, or those with a cardiac pacemaker in the shockwave field. Please inform the team of all medical conditions.
You can drive yourself to and from the appointment.
03
Risks and benefits
Key benefit
Non-invasive, no incisions
ESWL requires no surgery, no anaesthetic, and no hospital stay. It is a non-invasive option for suitable stones.
Common
Discomfort during treatment
You will feel a tapping or stinging sensation during the procedure. Oral analgesia is given beforehand. Most patients tolerate this well.
Common
Bruising and haematuria
Mild bruising over the treatment area and blood in the urine are common and usually resolve within a few days.
Uncommon
Steinstrasse (stone street)
Fragments can occasionally line up and obstruct the ureter as they pass — causing pain and requiring further treatment with ureteroscopy.
Uncommon
Incomplete fragmentation
Some stones — particularly hard calcium oxalate monohydrate or brushite stones — do not respond well to shockwaves and may require an alternative treatment.
04
Aftercare and recovery
1
Hydration is essential
Drink 2–3 litres of water per day to help flush fragments through the urinary system. Urinate through a sieve or strainer to catch stone pieces for analysis.
2
Pain relief
You may experience renal colic (loin pain) as fragments pass. Over-the-counter anti-inflammatories are usually effective. Strong or persistent pain should be reported.
3
Return to activity
You can return to normal activities, including work, the same or following day. Strenuous exercise should be avoided for 48 hours.
4
Follow-up imaging
A follow-up X-ray or CT scan is arranged at 4–6 weeks to assess stone clearance and determine if further treatment is needed.
01
Ureteroscopy with laser lithotripsy (URS)
Ureteroscopy involves passing a thin, flexible telescope through the urethra and bladder into the ureter or kidney — with no cuts or incisions. Once the stone is located, a laser (holmium laser) is used to break it into small fragments, which are then removed with a basket or allowed to pass naturally.
URS is an effective treatment for stones in the ureter and small to medium stones in the kidney. It is performed under general anaesthetic and is usually a day case procedure. A small stent (a thin tube called a JJ stent) is often left inside the ureter after the procedure for 1–2 weeks to allow healing and prevent blockage.
02
Before your procedure
Fast for six hours before surgery.
Blood-thinning medications should be paused as directed.
Urine must be infection-free before the procedure. A pre-operative urine culture is standard.
Arrange for someone to take you home. Most patients go home the same day.
03
Risks and benefits
Key benefit
Treats the stone directly
URS clears the stone in a single procedure for most patients, and the laser can break up hard stones.
Common
Stent-related symptoms
If a stent is placed, it can cause urinary frequency, urgency, loin discomfort, and mild blood in the urine. These symptoms resolve when the stent is removed, usually at 1–2 weeks.
Uncommon
Urinary tract infection
Infection rates are low with pre-procedure antibiotics but can occur. A fever after the procedure should be treated promptly.
Rare
Ureteral injury or stricture
Very rarely, the ureter may be perforated or develop a stricture (narrowing) later, requiring further treatment.
04
Aftercare and recovery
1
Hydration
Drink 2–3 litres of fluid per day. Blood-stained urine is normal for a few days — this improves with good hydration.
2
Stent removal
If a stent was placed, it is removed at a separate outpatient appointment 1–2 weeks later — usually via flexible cystoscopy. This is a quick procedure.
3
Return to activity
Most patients return to work within 1–2 days and can resume all activities within a week of stent removal.
4
Stone prevention
Your stone fragments may be sent for composition analysis. Dr Tan will advise on dietary and fluid changes to reduce the risk of future stones.
01
Percutaneous nephrolithotomy (PCNL)
PCNL is used to treat large or complex kidney stones (typically over 2 cm) that cannot be adequately managed with ESWL or ureteroscopy. A small tract is created through the skin into the kidney under general anaesthetic and X-ray guidance, and a nephroscope is passed directly into the kidney to fragment and remove the stone. This allows large or hard stones to be removed, often in a single procedure.
02
Before your procedure
Full pre-operative assessment including blood tests, kidney function, and urine culture.
Fast for six hours before surgery. Blood-thinning medications must be paused.
PCNL requires a hospital stay of typically 1–3 nights. Arrange home support for the first few days after discharge.
Stopping smoking is strongly encouraged before any procedure involving general anaesthesia.
03
Risks and benefits
Key benefit
Suited to large or complex stones
PCNL clears the stone for most patients with large or complex stones, usually in a single procedure.
Common
Pain and discomfort
Pain around the back and the nephrostomy tube site is expected. This is managed with prescribed pain relief and settles significantly within a few days.
Uncommon
Bleeding
Blood in the urine is expected. Occasionally, bleeding may be significant enough to require a blood transfusion or, rarely, embolisation of a blood vessel.
Uncommon
Infection / sepsis
Despite prophylactic antibiotics, infection from bacteria trapped within stones can occasionally cause a systemic infection requiring IV antibiotics and extended hospital stay.
Rare
Injury to surrounding structures
Injury to the bowel, lung (pneumothorax), or blood vessels adjacent to the kidney is rare but possible, particularly for upper-pole access.
04
Aftercare and recovery
1
Nephrostomy tube
A tube is left in the kidney overnight to drain urine and any residual blood. This is usually removed the morning after surgery once urine is running clear.
2
Imaging check
A plain X-ray or CT scan is performed before discharge to confirm adequate stone clearance. A JJ stent may be left in the ureter for 1–2 weeks.
3
Hydration
Drink 2–3 litres of fluid per day during recovery. Urine should run clear within a few days of discharge.
4
Return to activity
Most patients return to desk work within 1–2 weeks. Strenuous activity and heavy lifting should be avoided for 4 weeks.
Which procedure is most appropriate for my stone’s size and location?
What is the stone clearance rate for my chosen procedure?
Will I need a stent — and how long will it stay in?
How can I prevent stones from forming again?
Should my stone be sent for composition analysis?
Is there anything in my diet contributing to stone formation?
Disclaimer
This information is for general education and is not a substitute for personal medical advice.
Content adapted from the British Association of Urological Surgeons (BAUS) and the American Urological Association (AUA) patient information resources.