Introduction
Urinary stones are hard deposits that can form anywhere in the urinary system, including the kidneys, ureters, bladder, and occasionally the urethra. Small stones may sometimes pass naturally with appropriate medical management, but larger stones, persistent obstruction, severe symptoms, infection, or stones that are unlikely to pass may require a procedure for removal.
Urinary stone surgery does not refer to one single operation. The appropriate procedure depends on the stone's size, location, number, composition, anatomy of the urinary tract, kidney function, presence of obstruction, infection, and the patient's overall health.
Common stone-removal procedures include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy with laser lithotripsy, retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PCNL).
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, evaluates kidney stone patients, assesses kidney function and metabolic risk factors, and helps determine when specialist stone treatment or urological intervention may be required. Procedural stone removal is generally performed by an appropriately trained urologist.
What Are Urinary Stones?
Urinary stones form when certain substances in urine become concentrated and crystallize.
Common stone types include:
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Calcium oxalate stones
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Calcium phosphate stones
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Uric acid stones
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Struvite or infection-related stones
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Cystine stones
Stones may remain inside the kidney without causing symptoms or may move into the ureter and obstruct urine flow.
When Is Urinary Stone Surgery Needed?
Not every urinary stone requires surgery.
Small stones may pass naturally, particularly when they are located in the ureter and there is no infection or significant obstruction.
A procedure may be recommended when:
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The stone is unlikely to pass naturally
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Pain remains severe or recurrent
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The stone causes persistent urinary obstruction
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Kidney function is affected
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Hydronephrosis develops
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The stone continues to grow
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There are recurrent urinary infections
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The stone causes repeated bleeding or urinary symptoms
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The stone is large or associated with a significant stone burden
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A stone remains despite appropriate conservative management
The decision should be based on imaging, symptoms, kidney function, and the patient's individual circumstances.
Urinary Stone Surgery Options
1. Extracorporeal Shock Wave Lithotripsy
ESWL uses externally generated shock waves to break a urinary stone into smaller fragments.
The fragments can then pass through the urinary tract in the urine.
ESWL May Be Considered For
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Selected kidney stones
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Selected ureteral stones
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Stones of suitable size and location
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Patients without certain anatomical or medical contraindications
Advantages
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No surgical incision
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Non-invasive approach
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Usually performed as a day-care procedure
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Recovery is generally relatively quick
Limitations
ESWL is not suitable for every stone.
Its effectiveness may be influenced by:
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Stone size
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Stone location
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Stone composition
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Stone density
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Body habitus
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Urinary anatomy
Multiple treatment sessions may sometimes be required.
2. Ureteroscopy With Laser Lithotripsy
Ureteroscopy involves passing a thin scope through the urinary passage into the ureter or kidney.
A laser may then fragment the stone into smaller pieces, which can be removed or allowed to pass naturally.
Ureteroscopy May Be Used For
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Ureteral stones
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Kidney stones
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Stones that have not passed naturally
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Selected stones unsuitable for ESWL
Benefits
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Direct visualization of the stone
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High stone clearance potential for many appropriately selected stones
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Can treat stones in different locations within the urinary tract
A temporary ureteral stent may sometimes be placed after the procedure.
3. RIRS
Retrograde Intrarenal Surgery (RIRS) is a minimally invasive procedure used to treat stones located inside the kidney.
A flexible ureteroscope is guided through the urinary tract into the kidney. A laser is then used to fragment the stone.
RIRS May Be Suitable For
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Selected kidney stones
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Stones in difficult kidney locations
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Patients for whom ESWL is less suitable
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Selected moderate stone burdens
The exact choice depends on stone size, location, anatomy, and other patient-specific factors.
4. PCNL
Percutaneous Nephrolithotomy (PCNL) is generally used for larger or more complex kidney stone burdens.
A small tract is created through the skin into the kidney, allowing instruments to reach and remove or fragment the stone.
PCNL May Be Recommended For
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Large kidney stones
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Staghorn or complex stones
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Large stone burden
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Stones unlikely to be cleared effectively using less invasive procedures
PCNL can provide high stone clearance for appropriately selected large stones, but it is more invasive than ESWL or ureteroscopy.
5. Bladder Stone Procedures
Stones located in the bladder may require a different approach.
Depending on their size and characteristics, treatment may involve endoscopic fragmentation and removal.
The underlying reason for bladder stone formation should also be evaluated because urinary obstruction or incomplete bladder emptying can contribute to recurrence.
How Is the Right Urinary Stone Surgery Selected?
There is no single procedure that is best for every patient.
A specialist may consider:
Stone Size
Larger stones are generally less likely to pass naturally.
Stone Location
A stone in the kidney may require a different approach from a stone in the ureter or bladder.
Stone Composition
Some stones are harder and may respond differently to shock waves or laser treatment.
Stone Density
CT imaging can provide information about stone density and may help in treatment planning.
Urinary Anatomy
The anatomy of the kidney and urinary tract can influence procedural selection.
Kidney Function
Existing kidney disease may affect treatment planning and medication choices.
Infection
An infected obstructed urinary system requires urgent medical management and drainage rather than simply proceeding with elective stone removal.
Previous Procedures
Previous stone treatments, stents, or surgeries may influence the next treatment approach.
What Tests Are Needed Before Urinary Stone Surgery?
A detailed evaluation helps determine the safest and most effective treatment.
Investigations may include:
Urine Tests
These may detect:
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Blood
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Protein
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Infection
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Crystals
A urine culture may be recommended when infection is suspected.
Blood Tests
Depending on the situation, tests may include:
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Serum creatinine
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eGFR
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Electrolytes
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Complete blood count
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Blood glucose
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Other tests before anesthesia when required
Imaging
Imaging may include:
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Ultrasound
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X-ray in selected cases
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Non-contrast CT scan
CT is particularly useful for determining stone size, location, number, density, and urinary obstruction.
What Happens During Urinary Stone Surgery?
The exact steps depend on the procedure.
For minimally invasive procedures such as ureteroscopy or RIRS:
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The patient receives appropriate anesthesia.
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A thin scope is introduced through the urinary tract.
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The stone is located.
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A laser may fragment the stone.
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Fragments may be removed or allowed to pass.
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A temporary stent may be placed when necessary.
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The patient is monitored during recovery.
For PCNL, access to the kidney is obtained through a small tract created through the skin, allowing instruments to fragment and remove larger stones.
What Is a Ureteral Stent?
A ureteral stent is a thin tube placed inside the ureter to help urine flow from the kidney to the bladder.
A stent may be used after some stone procedures to:
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Maintain urine drainage
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Reduce the risk of obstruction from swelling or fragments
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Support healing of the urinary tract
Some patients experience:
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Frequent urination
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Urgency
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Burning while urinating
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Mild blood in the urine
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Flank or bladder discomfort
These symptoms are often temporary, but patients should follow their urologist's instructions regarding stent removal or replacement.
Recovery After Urinary Stone Surgery
Recovery varies according to the procedure.
After ESWL
Patients may usually return to normal activities relatively quickly, although passing stone fragments may cause discomfort.
After Ureteroscopy or RIRS
Mild urinary discomfort or blood in the urine may occur temporarily. Activity restrictions depend on the procedure and individual recovery.
After PCNL
Recovery generally takes longer because PCNL involves a percutaneous kidney access tract.
Patients should follow instructions regarding:
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Medication
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Fluid intake
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Activity
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Wound care when applicable
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Follow-up imaging
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Stent removal
Possible Risks of Urinary Stone Surgery
Although urinary stone procedures are commonly performed, complications are possible.
Potential risks include:
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Bleeding
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Infection
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Urinary tract injury
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Temporary urinary discomfort
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Residual stone fragments
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Need for another procedure
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Stent-related symptoms
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Anesthesia-related complications
The specific risks depend on the procedure and the patient's health.
What If a Stone Causes Infection?
An obstructed urinary system combined with infection can be a medical emergency.
Symptoms may include:
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Fever
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Chills
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Severe flank pain
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Vomiting
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Weakness
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Reduced urine output
In such circumstances, the priority is usually to establish urinary drainage and treat the infection. Definitive stone removal may be performed after the infection has been appropriately controlled.
Do not attempt to treat an infected obstruction at home.
Can Urinary Stones Be Treated Without Surgery?
Yes, selected stones can pass naturally.
Management may include:
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Appropriate fluid intake
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Pain management
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Medicines that may support passage of selected ureteral stones
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Monitoring with imaging
However, most urinary stones cannot simply be dissolved with water or herbal remedies.
Selected uric acid stones may sometimes be dissolved with medically supervised urine alkalinization.
The correct treatment depends on stone composition and clinical circumstances.
How to Prevent Future Urinary Stones
Removing a stone does not necessarily prevent another stone from forming.
Preventive care may include:
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Drinking an appropriate amount of fluid
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Reducing excessive salt intake
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Maintaining a balanced diet
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Avoiding excessive intake of foods associated with a particular stone type
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Maintaining a healthy body weight
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Treating urinary infections appropriately
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Taking preventive medication when indicated
For recurrent stones, a metabolic evaluation may help identify the reason for stone formation.
Depending on the patient's history, evaluation may include blood tests and a 24-hour urine analysis.
Why Choose Prabhakar Bhurke Clinic?
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, provides comprehensive evaluation for patients with urinary stones and related kidney problems.
Care may include:
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Kidney function assessment
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Evaluation of recurrent urinary stones
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Stone-related metabolic evaluation
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Assessment of kidney damage or obstruction
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Guidance regarding stone prevention
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Management of associated kidney disease
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Coordination with experienced urology specialists for procedural stone removal
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Dialysis and advanced kidney care when medically required
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Long-term kidney health monitoring
The goal is to select an appropriate treatment pathway while protecting kidney function and reducing the risk of recurrent stones.
Frequently Asked Questions
Is urinary stone surgery always necessary?
No. Some small stones can pass naturally with appropriate medical management. Surgery or a procedure may be recommended when a stone is large, obstructing, causing persistent symptoms, associated with infection, or unlikely to pass.
What is the best surgery for urinary stones?
There is no single best procedure for every stone. ESWL, ureteroscopy, RIRS, and PCNL are selected according to stone size, location, density, anatomy, kidney function, and other factors.
Is laser treatment safe for urinary stones?
Laser lithotripsy is a commonly used method for fragmenting urinary stones during ureteroscopy or RIRS. As with any procedure, there are potential risks that should be discussed with the treating urologist.
How long does urinary stone surgery take?
The duration varies depending on the procedure, stone size, number, location, and complexity. The treating specialist can provide an individualized estimate after reviewing the imaging.
Can urinary stones come back after surgery?
Yes. Stone removal treats the existing stone but does not always eliminate the factors that caused it. Dietary measures, metabolic evaluation, and preventive treatment can help reduce recurrence.
Can kidney stones be removed without surgery?
Some small stones can pass naturally. However, larger, obstructing, infected, or persistent stones may require an active procedure.
Which doctor performs urinary stone surgery?
Procedures such as ureteroscopy, RIRS, ESWL, and PCNL are generally performed by a trained urologist. A nephrologist evaluates kidney function, medical causes of recurrent stones, and associated kidney disease and can coordinate care when needed.
Conclusion
Urinary stone surgery includes several different procedures designed to remove or fragment stones from the kidney, ureter, or bladder. ESWL, ureteroscopy with laser lithotripsy, RIRS, and PCNL each have specific applications.
The right treatment depends on the stone's size, location, composition, density, urinary anatomy, kidney function, symptoms, and presence or absence of infection. Not every stone requires surgery, but delaying treatment for an obstructing or infected stone can put kidney health at risk.
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, provides comprehensive kidney evaluation, stone-related kidney care, metabolic assessment, prevention guidance, and coordination with appropriate urology specialists when procedural stone removal is required.
Book an Appointment Today
If you have been diagnosed with a urinary stone, recurrent kidney stones, ureteral stones, hydronephrosis, blood in the urine, persistent flank pain, or reduced kidney function, schedule a consultation at Prabhakar Bhurke Clinic.
Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, can evaluate your kidney health, assess the underlying risk factors, explain available treatment pathways, and coordinate specialist care when urinary stone surgery is required.
Medical Disclaimer
This article is intended for general educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The choice of urinary stone treatment depends on individual imaging findings, stone characteristics, kidney function, infection status, and overall health. Do not delay medical evaluation for severe pain, fever, chills, persistent vomiting, difficulty passing urine, or significantly reduced urine output.
