Kidney Stone Treatment Options: Lithotripsy, Ureteroscopy, and PCNL Compared
By Dr. Christopher Vendryes, MD · Board-Certified Urologist · · 5 min read
Quick answer: Small kidney stones, generally under 5 mm, often pass on their own, sometimes with medication that relaxes the ureter. Stones that don't pass, are large, cause infection, or block the kidney need a procedure. The three main options are shockwave lithotripsy (SWL), which breaks stones with sound waves from outside the body; ureteroscopy, which uses a thin scope and laser to break up and remove stones; and percutaneous nephrolithotomy (PCNL), a minimally invasive surgery through the back for large stones, usually over 2 cm.
When does a stone need treatment?
- It's too large to pass, or hasn't passed after a few weeks
- Pain can't be controlled
- It's blocking urine flow from the kidney
- There's an infection with fever, which is an emergency
- You have a single kidney or another medical reason
How do the procedures compare?
| Shockwave Lithotripsy | Ureteroscopy | PCNL | |
|---|---|---|---|
| How it works | Sound waves break the stone from outside | Scope through the urethra; laser breaks the stone | Small incision in the back to reach the kidney |
| Incisions | None | None | One small incision |
| Best for | Smaller kidney stones in favorable positions | Stones in the ureter or kidney, many sizes | Large stones, usually over 2 cm |
| Stone-free rate | Lower for larger or dense stones | High | Highest for large stones |
| Recovery | A day or two | A few days; often a temporary stent | About one to two weeks; often a hospital stay |
What is a ureteral stent?
A stent is a thin, soft tube placed between the kidney and bladder to keep urine flowing while swelling settles. It's common after ureteroscopy and is usually removed within days to a couple of weeks. Stents can cause urgency, frequency, blood in the urine, and discomfort until they're removed.
What if I have fever with a stone?
An infected, blocked kidney is an emergency. The first step is draining the kidney with a stent or a tube placed through the back. The stone is treated later once the infection clears. Go to the emergency room for stone pain with fever or chills.
How do I prevent the next stone?
About half of people who have one stone will have another within years. Stone analysis and a 24-hour urine test guide prevention. Read The Kidney Stone Diet and Kidney Stones in South Florida.
Frequently Asked Questions
Talk to a Board-Certified Urologist
Dr. Vendryes sees patients in Plantation and across Broward and Palm Beach Counties for men's health, fertility, kidney stones, urologic cancers, and bladder problems.
References
- American Urological Association / Endourological Society. Surgical Management of Stones Guideline. 2016, amended.
- Urology Care Foundation. Kidney Stones: Treatment.
- National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Kidney Stones.