Kidney stone treatment depends on the stone’s size, location, and whether it blocks urine flow or causes complications. Small stones may pass naturally with fluids, pain relief, and sometimes medicine to help them move. Larger, stuck, or infection-related stones may need a procedure to break them apart or remove them. A clinician chooses the safest option after assessing symptoms, tests, kidney function, and overall health.
How Do Doctors Choose the Right Kidney Stone Treatment?
Not every kidney stone needs surgery. Some stones can pass through the urinary tract without a procedure, while others need medical treatment to prevent a blockage or protect kidney function. The decision depends on the stone’s size, position, suspected type, the symptoms it causes, and whether there are problems such as infection or impaired urine flow.
A healthcare professional may review medical history, examine the patient, and request urine tests, blood tests, or imaging. Ultrasound and computed tomography (CT) scans can help identify stones and show where they are located. These findings help determine whether monitoring is reasonable or whether a procedure is more appropriate. According to Mayo Clinic, testing may also help identify factors that contribute to stone formation and guide prevention after treatment.
Can Small Kidney Stones Pass Without Surgery?
Yes. Small kidney stones may pass naturally in the urine. When a stone is likely to pass safely, a clinician may recommend observation instead of immediate removal. This approach involves following the care plan, monitoring symptoms, and attending any recommended follow-up appointments. The time needed for a stone to pass varies, and a stone that remains stuck or causes complications may require a different approach.
Drinking enough fluid may help urine flow and support the passage of a stone, but the recommended amount depends on the person's health and circumstances. Someone who has been told to restrict fluids because of kidney or heart problems should follow that advice rather than increasing intake independently. A clinician may also recommend using a urine strainer to collect a passed stone for laboratory analysis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains that stone analysis can help determine its type and guide future care.
What Medicines Are Used for Kidney Stones?
Medicines may reduce discomfort, control nausea, help certain stones pass, or lower the chance of future stones. The choice depends on the person's symptoms, kidney function, other medical conditions, and the suspected or confirmed stone type. Medicines can be useful while waiting for a stone to pass, but they cannot replace a procedure when a stone causes a serious blockage or another complication.
Pain relief and medicines to help a stone pass
A healthcare professional may recommend pain-relieving medicine and, when needed, treatment for nausea or vomiting. Anti-inflammatory pain medicines can help some people, but they are not suitable for everyone, especially those with certain kidney problems or other medical risks. A clinician should guide the choice and dose rather than relying on a general recommendation.
In selected cases, an alpha-blocker such as tamsulosin may be prescribed to relax the muscles in the ureter, the tube connecting the kidney to the bladder. This may help a stone pass. It is not necessary or effective for every stone, so the decision depends on factors such as the stone's location and the person's overall condition. Cleveland Clinic describes these medicines as one option alongside symptom relief and procedures when a stone is unlikely to pass naturally.
Medicines to prevent future stones
Some people benefit from long-term medicine to reduce the risk of another kidney stone. For example, depending on the stone type and test results, a clinician may prescribe potassium citrate, a medicine that affects urine chemistry, or another medicine that reduces the buildup of stone-forming substances. Antibiotics may be needed when a bacterial infection is present, and some infection-related stones require additional specialist treatment.
Preventive medicines are selected according to the underlying cause and may require monitoring with blood or urine tests. They should not be started, stopped, or adjusted without medical guidance.
What Procedures Can Break Up or Remove Kidney Stones?
A procedure may be recommended when a stone is too large to pass, blocks urine flow, causes persistent symptoms, or is associated with kidney damage or repeated infection. Several techniques are available. The most suitable option depends on stone size, location, number, anatomy, and the person's health. Some procedures break a stone into smaller pieces, while others remove it directly.
Shock wave lithotripsy
Shock wave lithotripsy uses focused sound waves delivered from outside the body to break a kidney stone into smaller fragments. The fragments can then pass through the urinary tract in the urine. The procedure does not require a cut in the skin, although pain relief or anaesthesia may be used as needed.
This approach is suitable for certain stones, but it does not work equally well for every size or position. Some people need additional treatment if fragments remain or the stone does not break apart sufficiently. Temporary blood in the urine, bruising, discomfort, or problems caused by passing fragments can occur.
Ureteroscopy
During ureteroscopy, a urologist passes a thin viewing instrument through the urethra and bladder into the ureter or kidney. The instrument allows the doctor to locate the stone and, when appropriate, break it into smaller pieces using a laser or remove it with a small basket.
The procedure is usually performed with anaesthesia. Many patients can return home the same day, although the recovery plan depends on the procedure and individual circumstances. A temporary ureteral stent may be placed to help urine drain while swelling settles or fragments pass. The stent may cause urinary discomfort and needs to be removed or exchanged according to the treatment plan.
Percutaneous nephrolithotomy
Percutaneous nephrolithotomy (PCNL) is commonly considered for larger or more complex kidney stones that are unlikely to be managed adequately with other methods. The surgeon makes a small cut in the back and passes a narrow instrument directly into the kidney to break up and remove the stone.
This procedure is performed in a hospital with anaesthesia and may require an overnight stay or a longer recovery period. As with other procedures, the team discusses possible complications, which can include bleeding and infection, before treatment.
What if urine cannot drain from the kidney?
When a stone blocks urine flow, the immediate priority may be to relieve the blockage rather than remove the stone straight away. A clinician may place a ureteral stent, a thin tube that allows urine to drain from the kidney into the bladder, or a nephrostomy catheter, which drains urine through a tube inserted into the kidney from the back. These measures can help protect kidney function and support treatment of infection. According to Guy's and St Thomas' NHS Foundation Trust, a nephrostomy catheter provides temporary drainage when the ureter is blocked. The stone can then be treated when it is safe to do so.
When Is Kidney Stone Treatment Urgent?
Some kidney stones require urgent medical assessment, particularly when severe pain, infection, or a blockage is suspected. Seek urgent care if symptoms include:
- Severe or worsening pain in the back, side, abdomen, or groin.
- Fever, chills, or feeling unusually hot or shivery.
- Difficulty passing urine or being unable to urinate.
- Repeated vomiting or difficulty keeping fluids down.
- Symptoms that persist, worsen, or are accompanied by feeling very unwell.
A stone blocking the urinary tract alongside an infection can be especially serious. It may require hospital treatment, antibiotics, and urgent drainage of the kidney. Do not wait for a stone to pass on its own when warning signs are present. The NHS guidance on kidney stones advises urgent medical help for symptoms such as severe pain or a high temperature with suspected stones. In children, assessment and treatment need to be tailored to age; imaging choices can also differ from those used for adults.
What Happens After a Kidney Stone Passes or Is Removed?
Passing a stone or having it removed does not always mean that all follow-up is complete. A healthcare professional may recommend imaging or another assessment to confirm that the stone has cleared and that urine is draining normally. If a stent was placed, the care team will explain when it should be removed or exchanged.
When possible, the stone or its fragments may be sent to a laboratory to identify their mineral composition. People who have repeated stones, unusual stone types, or other risk factors may need blood tests or a 24-hour urine collection. These assessments can reveal patterns that influence preventive treatment.
How Can You Reduce the Risk of More Kidney Stones?
Prevention depends on the type of stone and why it formed. Drinking enough fluid, mainly water, can help dilute urine and reduce the concentration of substances that form stones. The right fluid intake varies with activity, climate, and medical conditions, so people who have been advised to restrict fluids need an individualized plan.
Dietary changes may also help. Depending on the stone type and test results, a healthcare professional may recommend reducing excess sodium, adjusting animal protein intake, or changing the amount of oxalate in the diet. Adequate calcium from food is still important for many people, so eliminating calcium-rich foods without advice is not a suitable general prevention strategy. The NIDDK guidance on eating and nutrition for kidney stones explains how fluid intake and food choices can be adjusted according to a person's stone history.
People who have had a kidney stone should discuss their risk of recurrence with a healthcare professional. A personalized plan may include dietary changes, preventive medicines, or repeat urine tests. These steps aim to reduce the chance of future stones while taking the person's broader health needs into account.