Kidney stones: shockwave, ureteroscopy or surgery?
About one in ten people will have a kidney stone. Small stones (under about 5 mm) usually pass on their own with fluids, pain control and sometimes a medication that relaxes the ureter. Larger stones, or stones causing infection, blockage or pain that won't settle, need treatment.
Fever with a kidney stone is an emergency. An infected, blocked kidney needs drainage the same day. Go to an emergency department.
The three main treatments
Shockwave lithotripsy (ESWL) breaks the stone from outside the body under sedation. There is no incision and nothing passes up the urinary tract, and most patients go home the same day without a stent. It works best for stones up to about 1.5 cm in the kidney or upper ureter. Very hard stones (high density on CT) break less reliably, and a second session is sometimes needed. A failed ESWL doesn't rule out anything else, so it is often a sensible first attempt.
Ureteroscopy passes a thin scope up the urethra and bladder to the stone, which is broken with a laser and removed. Stone-free rates are high, but a temporary stent is often left in afterward. Stents are uncomfortable for many people and need to be removed in a second step.
Percutaneous nephrolithotomy (PCNL) reaches very large kidney stones through a small tract in the back. It is the most effective option for big stones and also the most invasive, with a hospital stay and bleeding risk.
Preventing the next one
- Drink enough to make about 2 to 2.5 liters of urine a day. Pale urine is the goal.
- Cut salt. Sodium drives calcium into the urine.
- Don't cut dietary calcium. Low-calcium diets make the most common stones more likely.
- If you've had more than one stone, ask for a 24-hour urine test and a stone analysis.
Questions to ask
- Is my stone a candidate for shockwave lithotripsy?
- Will I need a stent, and when does it come out?
- What did the stone analysis show, and what should I change?