Nephrology focuses on diagnosing and treating kidney diseases. The kidneys filter waste, balance fluids, regulate blood pressure, and manage acute and chronic conditions.
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Treating kidney stones is a two-phase process. The first phase is the acute management: dealing with the stone that is currently causing pain. This involves a decision between letting it pass naturally or intervening surgically. The second phase is long-term management and follow-up to ensure the stone is gone and monitor kidney health.
The choice of treatment depends almost entirely on the size and location of the stone. Small stones, measuring less than 5 mm, are more likely to dissolve on their own. Large stones (over 10 mm) almost never pass and require surgery. The “middle zone” (5-10 mm) is where shared decision-making between doctor and patient comes into play.
For smaller stones causing manageable pain, the strategy is “Medical Expulsive Therapy” (MET).
Pain management is the priority. Doctors typically prescribe NSAIDs (like ibuprofen or ketorolac) because they treat pain and reduce inflammation in the ureter. Opioids may be used for severe breakthrough pain but are used cautiously.
Patients are told to drink plenty of water to generate pressure behind the stone to push it out. Additionally, a medication called Tamsulosin (Flomax) is often prescribed. This substance is an alpha-blocker that relaxes the muscles of the ureter, essentially widening the tube to help the stone slide through more easily and with less pain.
For stones that are too large to pass but are located in the kidney or upper ureter, shock wave lithotripsy is a common noninvasive option.
The patient lies on a table, and a machine sends high-energy sound waves through the skin directly at the stone. These shock waves shatter the stone into sand-like fragments. The patient then passes these fragments in their urine over the coming days or weeks. It works best for softer stones and patients who are not obese (as the waves need to penetrate to the stone).
This is a minimally invasive procedure with no incisions. It is the most common treatment for stones stuck in the ureter.
The surgeon inserts a tiny, flexible telescope (ureteroscope) through the urethra and bladder, up into the ureter. Once they reach the stone, they use a laser fiber to blast it into dust. A small wire basket might be used to grab larger pieces. Often, a temporary plastic tube called a stent is placed in the ureter to keep it open and allow swelling to go down. The stent is usually removed in the doctor’s office a week later.
For very large stones (over 2 cm) or staghorn calculi in the kidney, percutaneous nephrolithotomy (PCNL) is required.
This is a more invasive surgery. The surgeon makes a small incision (about 1 cm) in the back, directly into the kidney. They insert a tube and use specialized instruments to break up and suck out the large stone fragments. The technique has the highest success rate for clearing big stones but carries a slightly higher risk and longer recovery than other methods.
Occasionally, a stone causes a medical emergency called an obstructed infected kidney. This happens when a stone blocks the ureter and bacteria multiply in the trapped urine behind it. This is sepsis waiting to happen.
In this case, the priority is not removing the stone but draining the infected urine. A doctor will urgently place a ureteral stent (from below) or a nephrostomy tube (a tube placed through the back directly into the kidney) to bypass the blockage and drain the pus. Stone removal is delayed until the infection is cleared with antibiotics.
After any stone event, follow-up is critical for guaranteeing the stone is actually gone.
Patients typically return for an X-ray or ultrasound 2-4 weeks after treatment. This checks for “retained fragments.” Even small leftover pieces can act as seeds for new stones to grow on. If a stent was placed, the follow-up appointment is when it is removed. A removal is a quick in-office procedure that takes only a few seconds but can be uncomfortable.
The ureteral stent is often the most complained-about part of stone treatment. It is an unavoidable inconvenience.
The stent curls at both ends (double-J stent) to stay in place between the kidney and bladder. It can cause bladder spasms, urgency, and blood in the urine. It can also cause flank pain during urination (reflux). Patients are encouraged to drink fluids and take medications like tamsulosin or bladder relaxants to manage stent discomfort until it is removed.
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The procedure itself is done under sedation or anesthesia, so you don’t feel it. Afterward, the back can feel bruised and sore, and passing the fragments can be uncomfortable.
It often feels like a constant need to urinate or a scratching sensation inside. Some people feel a dull ache in the kidney when they pee.
The doctor uses a cystoscope (a small camera) to look into the bladder, grabs the string or the end of the stent with a tiny grasper, and pulls it out. It takes about 10 seconds.
Yes, but you might need frequent bathroom breaks and may be uncomfortable. Heavy physical activity can cause more blood in the urine while the stent is in.
If the stone hasn’t moved after 4-6 weeks, or if pain is uncontrollable, surgery is usually recommended to prevent permanent kidney damage.
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