Common Condition
Kidney Stones
Kidney stones are one of the most common conditions treated by urologists. While many stones pass without surgery, others require treatment to relieve pain, protect the kidney, or prevent infection. The best treatment depends on your individual situation.
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Kidney Stones at a Glance
Common Symptoms
- Severe flank pain
- Blood in the urine
- Nausea or vomiting
- Urinary urgency or frequency
Treatment Options
- Observation
- Medical therapy
- Ureteroscopy
- Shockwave lithotripsy
- PCNL
Seek Urgent Care If...
- Fever or chills
- Uncontrolled pain
- Persistent vomiting
- Difficulty urinating
What are kidney stones?
Kidney stones are hard deposits that form when minerals in the urine become concentrated and crystallize. They can form in the kidney and may later move into the ureter, the narrow tube that drains urine from the kidney to the bladder.
Some stones pass on their own. Others become stuck, cause severe pain, block urine drainage, or lead to infection. The right treatment depends on the stone's size, location, symptoms, and the overall clinical situation.
Common Symptoms
- Severe flank pain that may radiate toward the groin.
- Blood in the urine, ranging from microscopic to visible blood.
- Nausea and vomiting, often accompanying severe pain.
- Urinary urgency or frequency, especially when a stone is near the bladder.
- Fever or chills may indicate an infected, obstructed kidney and require urgent medical attention.
How are kidney stones diagnosed?
Diagnosing a kidney stone involves more than simply confirming that a stone is present. The goal is to determine its size, location, whether it is causing obstruction, and whether there are signs of infection or kidney injury that require prompt treatment.
Urinalysis
A urine test can identify blood, signs of infection, crystals, and other findings that help guide diagnosis and treatment.
CT Scan
A non-contrast CT scan is usually the most accurate way to locate a stone, determine its size, and evaluate whether it is blocking the urinary tract.
Ultrasound & X-ray
In some situations, ultrasound or plain X-rays provide useful information while avoiding additional radiation exposure.
Blood Tests
Blood work may be obtained to evaluate kidney function, look for infection, and identify other medical issues that influence treatment.
Treatment Options
Not every kidney stone requires surgery. Treatment depends on the size and location of the stone, your symptoms, whether urine flow is blocked, whether infection is present, and your overall health. In many cases, treatment progresses from the least invasive approach to more advanced procedures only when necessary.
Observation
Small stones often pass on their own with time, hydration, pain medication, and close follow-up.
Medical Therapy
Certain medications may help relax the ureter and improve the chance of passing an appropriately sized stone.
Shockwave Lithotripsy (ESWL)
Shockwaves break selected stones into smaller fragments that can pass naturally through the urinary tract.
Ureteroscopy & Laser Lithotripsy
A small camera is passed through the urinary tract to directly visualize and fragment the stone using a laser.
Percutaneous Nephrolithotomy (PCNL)
Larger or more complex kidney stones may require removal through a small incision in the back.
Treatment Decisions
One of the most common questions is whether a kidney stone should be observed or treated. The answer is rarely based on one factor alone. Stone size and location matter, but so do symptoms, obstruction, infection risk, kidney function, previous stone history, and personal preference.
For example, someone with a first-time 6 mm stone in the upper ureter may reasonably choose a trial of passage if pain is controlled and there is no infection. That may include hydration, pain medication, close follow-up, and sometimes medication such as tamsulosin (Flomax).
On the other hand, stones of that size and location have a meaningful chance of causing another painful episode or requiring urgent care. For many patients, scheduling ureteroscopy electively is a reasonable choice. If the stone passes before surgery, the procedure can simply be canceled.
The goal is not simply to choose a treatment. It is to choose the treatment that best fits your condition, your goals, and your life.
What Many Patients Are Surprised to Learn
A bigger stone does not always hurt more.
Pain is often related to whether the stone is blocking urine flow, not simply how large it is. A very small stone lodged in the ureter can be extremely painful, while a larger stone sitting quietly in the kidney may cause no symptoms.
If the pain stops, the stone has not necessarily passed.
Pain may improve because the stone passed, but it can also improve if the stone changes position or the blockage becomes less severe. Whenever possible, stone passage should be confirmed by collecting the stone or with follow-up imaging.
Not every kidney stone needs surgery.
Many stones pass on their own. The decision to treat depends on much more than size, including symptoms, location, obstruction, infection risk, kidney function, and patient preference.
There is not always one right answer.
In many situations, observation and treatment are both reasonable. Good care means understanding the trade-offs and choosing the option that best fits the patient.
When should you see a urologist?
You should consider seeing a urologist if a stone has not passed after a reasonable period of observation, if symptoms continue, if stones recur, or if imaging shows a larger stone, multiple stones, growth over time, blockage, or possible kidney damage.
Evaluation is also important if stones are associated with recurrent urinary tract infections, kidney function problems, prior stone procedures, or if your travel, work, or personal schedule would make an unexpected stone attack especially difficult.
When should you seek urgent care?
Kidney stones are painful, but most are not immediately dangerous. However, certain symptoms require urgent evaluation.
- Fever or chills
- Uncontrolled pain despite medication
- Persistent vomiting or inability to keep fluids down
- Difficulty urinating
- Known blockage in a solitary kidney
Preventing future kidney stones
Prevention depends on why stones are forming, but the most important first step for many patients is improving hydration. Most stone formers do not drink enough fluid, and increasing daily fluid intake can significantly reduce the risk of future stones.
Other prevention strategies may include lowering sodium intake, maintaining normal dietary calcium, moderating excess animal protein, and completing a metabolic evaluation when stones are recurrent, complex, or unusual.