Kidney stones are hard deposits that form when certain substances in urine become concentrated and crystallise. Some small stones can pass naturally with fluids, pain relief, and medical monitoring. However, others can block urine flow, cause infection, impair kidney function, or produce persistent symptoms. Knowing when kidney stones treatment is needed can help patients understand why a urologist may recommend observation, medication, or a procedure.
What Are Kidney Stones?
Kidney stones are solid crystals that develop within the urinary system. They can remain in the kidney or move into the ureter, the narrow tube connecting the kidney to the bladder. A stone may cause no symptoms while it remains in the kidney, but symptoms can develop when it moves or obstructs urine flow.
Common features of kidney stones include:
- Sudden, severe pain in the side or back
- Pain that may move towards the lower abdomen or groin
- Blood in the urine
- Nausea or vomiting
- Frequent or painful urination when the stone is near the bladder
- Urinary obstruction or infection in more complicated cases
The size and location of the stone are important when deciding whether treatment is necessary.
Why Is Kidney Stones Treatment Important?
Not every kidney stone needs to be removed. Small stones may pass through the urinary tract without a procedure. However, a stone that remains lodged or obstructs urine flow can cause significant pain and may affect kidney function. An obstructed urinary system can also become infected, which requires prompt medical assessment.
Medical treatment may be considered when:
- The stone is unlikely to pass naturally.
- Pain continues despite appropriate medication.
- The stone causes urinary obstruction.
- There is an infection or a risk of infection.
- Kidney function is affected.
- The stone is growing or is likely to cause future complications.
Singapore’s Ministry of Health lists obstruction, infection, symptoms, renal impairment, and a low likelihood of spontaneous passage among clinical indications for certain stone procedures.
Who Should Consider Kidney Stones Treatment?
The need for treatment is determined after assessing the stone and the patient’s overall health. Imaging, such as ultrasound or CT, may help determine the stone’s size and location, while blood and urine tests can provide information about kidney function and infection.
Medical or procedural treatment may be considered for people who:
- Have stones that are too large to pass safely or are unlikely to pass.
- Have persistent or severe pain.
- Have recurrent blood in the urine associated with the stone.
- Have an obstructing stone.
- Have urinary infection associated with a stone.
- Have impaired kidney function, a single functioning kidney, or obstruction affecting both kidneys.
The decision is not based on stone size alone. Its location, symptoms, associated complications, and the patient’s individual circumstances also matter.
What Kidney Stones Treatment Options Are Available?
Treatment depends on the stone’s size, location, composition, symptoms, and potential complications.
Observation and Conservative Treatment
Small stones that are likely to pass naturally may initially be managed without surgery. Treatment can include adequate fluid intake, pain relief, and, in selected cases, medication such as an alpha blocker to help facilitate stone passage.
Patients should follow their doctor’s advice about fluid intake, particularly if they have kidney or heart conditions where excessive fluid may be unsuitable.
Extracorporeal Shock Wave Lithotripsy
Extracorporeal shock wave lithotripsy, or ESWL, uses externally generated shock waves to break a stone into smaller fragments. The fragments can then pass through the urinary tract.
ESWL may be considered for selected kidney or ureteric stones. More than one treatment session may sometimes be needed, depending on the stone and how well it fragments. Possible complications include blood in the urine, discomfort, bruising, and, rarely, obstruction caused by stone fragments.
Ureteroscopy
During ureteroscopy, a small scope is passed through the urinary tract into the ureter or kidney. Instruments can then be used to break the stone into smaller pieces or remove it using a small basket.
Ureteroscopy is used to treat ureteric stones, while flexible ureteroscopy can also be used for selected kidney stones. A temporary ureteric stent may sometimes be placed afterward to help maintain urine drainage while the ureter recovers.
Percutaneous Nephrolithotomy
Percutaneous nephrolithotomy, or PCNL, is generally used for larger or more complex kidney stones. A small access tract is created through the skin into the kidney, allowing instruments to break and remove the stone.
PCNL is performed under general anaesthesia. Potential complications include bleeding, urinary tract infection, injury to nearby structures, and residual stones.
Urgent Drainage
When a stone causes significant obstruction together with infection, the immediate priority may be to drain the kidney rather than remove the stone straight away. A ureteric stent or percutaneous nephrostomy may be used to restore urine drainage. Definitive stone treatment can then be considered after the acute infection has been managed.
How Should You Prepare?
Preparation depends on whether you are being monitored, receiving medication, or undergoing a procedure.
Before your appointment, it can help to:
- Bring previous imaging and medical reports.
- Provide a complete list of medications and supplements.
- Tell your doctor about medication allergies.
- Mention previous kidney stones and treatments.
- Report any fever, urinary symptoms, or changes in pain.
- Ask whether you need to fast before a procedure.
If surgery or another procedure is planned, the healthcare team will provide specific instructions about fasting, medications, anaesthesia, and recovery.
What Our Urology Team Says
Patients often ask whether every kidney stone needs to be removed. The answer is no. Some small stones can pass naturally with appropriate observation and symptom management. Others require intervention because they are unlikely to pass, continue causing significant symptoms, obstruct urine flow, or are associated with infection or impaired kidney function. During assessment, we consider the stone’s size and location together with the patient’s symptoms, kidney function, medical history, and risk factors. The aim is to select an appropriate management approach while considering both the potential benefits and risks of intervention. Follow-up may also be important to confirm that the stone has passed or that treatment has achieved its intended purpose.
Putting This Into Practice
- Keep copies of previous scans and urine or blood test results.
- Take prescribed pain medication according to medical advice.
- Follow recommended fluid intake rather than forcing excessive fluids.
- Attend follow-up imaging when advised.
- Ask what the stone’s size and location are.
- Discuss preventive measures if you have recurrent stones.
When to Seek Professional Help
Seek prompt medical attention if you:
- Develop severe or worsening flank or abdominal pain.
- Have fever or chills together with suspected kidney stones.
- Cannot keep fluids down because of persistent vomiting.
- Have difficulty passing urine.
- Notice significant blood in the urine.
- Have a known single functioning kidney with symptoms suggestive of obstruction.
Fever associated with an obstructing urinary stone can indicate a potentially serious infection and requires prompt medical assessment.
Frequently Asked Questions
How do I know if my kidney stone needs treatment?
A kidney stone may need treatment if it is unlikely to pass naturally, causes persistent or severe symptoms, blocks urine flow, is associated with infection, or affects kidney function. The stone’s size and location are important, but they are considered together with your symptoms and medical history. Imaging and other tests help your urologist determine the appropriate approach.
Can kidney stones pass without surgery?
Yes, some kidney stones can pass without a procedure. Smaller stones are generally more likely to pass naturally, particularly when they are located in parts of the urinary tract where passage is more feasible. Conservative management may involve pain relief, appropriate fluid intake, and sometimes medication. Follow-up may be needed to confirm that the stone has passed.
Is kidney stone treatment always painful?
No, but discomfort can occur with both stone passage and some treatments. ESWL may cause temporary pain or bruising, while ureteroscopy can cause urinary discomfort, particularly if a stent is placed afterward. PCNL involves a small incision and may cause postoperative discomfort. Anaesthesia and pain-management measures are used according to the procedure and individual circumstances.
What is the difference between ESWL and ureteroscopy?
ESWL breaks the stone from outside the body using shock waves, while ureteroscopy involves passing a small scope through the urinary tract to reach the stone directly. ESWL may be suitable for selected stones but can require more than one session. Ureteroscopy provides direct access and allows the stone to be fragmented or removed during the procedure.
Can kidney stones come back after treatment?
Yes, kidney stones can recur even after a stone has been successfully removed. Recurrence risk depends on factors such as stone type, fluid intake, dietary factors, medical conditions, and individual metabolism. If you have recurrent stones, your healthcare professional may recommend analysing the stone and assessing urine or blood factors to identify possible preventive measures.
Next Steps
Kidney stones treatment is not automatically necessary for every stone. Some can pass naturally with appropriate monitoring, while others require intervention because of their size, location, persistent symptoms, obstruction, infection, or effect on kidney function. Treatment options can include conservative management, ESWL, ureteroscopy, PCNL, or temporary drainage when urgent obstruction needs to be relieved. If you have symptoms suggestive of a kidney stone, particularly severe pain, fever, vomiting, or difficulty passing urine, seek medical assessment. A urologist can evaluate the stone and recommend an appropriate treatment plan based on your individual circumstances.
