A stone causing severe flank pain, repeated infection or blockage of urine flow needs timely assessment. Understanding how kidney stone surgery works can make the treatment pathway less daunting: the aim is usually to break up or remove the stone, restore drainage from the kidney and reduce the chance of ongoing pain or infection.
Kidney stone surgery is not a single operation. The most suitable procedure depends on the stone’s size, location and density, as well as the anatomy of the urinary tract, kidney function and whether infection or obstruction is present. CT imaging is commonly used to define these details before treatment is planned.
When kidney stones need surgery
Many small stones pass without an operation, particularly when they are located in the lower part of the ureter, the tube between the kidney and bladder. Pain relief, fluid advice and medication to assist stone passage may be appropriate in selected cases.
Surgery is considered when a stone is unlikely to pass, pain remains difficult to control, urine drainage is blocked, infection is present, kidney function is at risk, or stones are recurrent. Larger stones within the kidney may also require active treatment even if they are causing few symptoms, particularly if they are growing or associated with repeated urinary tract infections.
An infected obstructed kidney is an urgent situation. In this setting, the first priority is to drain the urine with a ureteric stent or a nephrostomy tube, together with antibiotics where required. Definitive stone treatment is generally delayed until the infection has settled.
How kidney stone surgery works: three common approaches
The procedure is selected to give the best prospect of clearing the stone with the lowest reasonable risk. More than one treatment may occasionally be needed, especially for large or multiple stones.
Shock wave lithotripsy
Shock wave lithotripsy, often called ESWL, uses focused sound waves generated outside the body to fragment a stone into smaller pieces. There are no surgical cuts. The fragments then pass through the urinary tract over the following days or weeks.
This treatment may suit selected kidney stones and upper ureteric stones, particularly when they are relatively small and not excessively dense. It is less suitable for some larger stones, very hard stones, stones in certain lower kidney locations, and when there is significant obstruction below the stone.
Shock wave treatment is usually performed as a day procedure, sometimes with sedation or anaesthesia depending on the individual circumstances. Passing fragments can cause temporary discomfort, blood in the urine and colic. A stent is not always required, but may be recommended in selected cases.
Ureteroscopy and laser stone treatment
Ureteroscopy is a minimally invasive procedure used for stones in the ureter and many stones within the kidney. While the patient is under general anaesthesia, a fine telescope is passed through the urethra and bladder into the ureter. No incision is made through the skin.
The surgeon identifies the stone directly and uses a laser to break it into dust or smaller fragments. Larger pieces may be removed with specialised instruments. Flexible ureteroscopy allows the surgeon to reach stones in different areas of the kidney through the natural urinary passage.
A temporary ureteric stent is commonly placed at the end of the procedure. This soft internal tube supports drainage while swelling settles and small fragments pass. It may cause urinary frequency, urgency, mild discomfort in the bladder or kidney area, and visible blood in the urine. These effects are usually temporary, but the stent must be removed or exchanged at the planned time.
Percutaneous nephrolithotomy
Percutaneous nephrolithotomy, or PCNL, is generally used for larger kidney stones, including stones that fill a substantial part of the kidney’s collecting system. It is also considered when other approaches are unlikely to provide adequate clearance.
Under general anaesthesia, a small tract is created through the skin of the back into the kidney. A telescope is passed directly into the kidney, allowing the stone to be broken up and removed. A drainage tube or stent may be left temporarily after surgery.
PCNL has a higher level of invasiveness than ureteroscopy or shock wave lithotripsy, but it is often the most effective option for a large stone burden. It usually requires a short hospital stay. The balance between a more involved procedure and the opportunity to clear substantial stones in one treatment is discussed carefully during consultation.
What happens before the procedure
Pre-operative planning starts with imaging and urine testing. A urine infection should be identified and treated before elective stone surgery, as operating in the presence of infection can increase the risk of serious complications. Blood tests may also be required to assess kidney function and general fitness for anaesthesia.
Your surgeon will review medications, particularly blood-thinning medicines, diabetes treatments and supplements. Do not stop prescribed medication without specific instructions from your treating team. Fasting requirements and when to arrive at hospital will be provided before the procedure.
Stone location can change between the original scan and the day of treatment if a stone passes or moves. In some cases, updated imaging is needed to confirm the treatment plan.
Recovery after stone surgery
Recovery varies according to the procedure, stone size and whether a stent or drainage tube is used. Most patients having ureteroscopy or shock wave lithotripsy return home the same day. After PCNL, one or more nights in hospital may be appropriate.
It is common to have mild burning when passing urine, blood-stained urine, urinary frequency and intermittent discomfort for a short period after treatment. Drinking fluids as advised can help maintain urine flow, although excessive fluid intake is not necessary if nausea or significant pain is present. Pain relief should be taken as prescribed.
You should seek urgent medical advice if you develop fever, chills, worsening pain not controlled by medication, persistent vomiting, difficulty passing urine, heavy bleeding or large blood clots. These symptoms can indicate infection, obstruction or another complication requiring prompt assessment.
A follow-up appointment may include imaging to check that the kidney is draining and to assess for residual fragments. If a stent has been inserted, ensure you understand how and when it will be removed. Keeping track of this date is an important part of safe post-operative care.
Risks and realistic expectations
All stone procedures carry some risk. These include bleeding, urinary infection, injury to the ureter or kidney, incomplete stone clearance and the need for a further procedure. Ureteroscopy can occasionally require temporary stenting because swelling prevents safe drainage. PCNL has additional risks associated with creating access to the kidney, including bleeding that may require further treatment, although serious complications are uncommon.
The goal is not simply to treat the stone visible on a scan. For recurrent stone formers, prevention also matters. Analysing retrieved stone material, reviewing diet and fluid intake, and considering blood or urine testing can help identify factors that contribute to new stones. Advice is individualised because the best prevention strategy depends on the stone type and medical history.
At Urology Health Adelaide, stone treatment is planned around the individual patient, with attention to safe drainage, minimally invasive options where appropriate and a clear plan for follow-up. The most helpful next step is a specialist review of your imaging and symptoms, so the procedure recommended reflects the stone you have rather than a one-size-fits-all approach.
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