Kidney stones: Learn More – Treatment options for kidney stones (2024)

Small kidney stones often pass out of the body on their own. As long as they don't cause severe pain or complications, treatment isn’t necessary. Larger kidney stones usually need to be treated. Depending on how large the kidney stones are and where they're located, they can be destroyed or removed using an endoscope (a flexible tube with a light and camera at the end of it).

Most kidney stones with a diameter of less than 5 millimeters, and about half of all stones between 5 and 10 millimeters, pass out of the body on their own. These smaller kidney stones are often flushed out in the urine after one or two weeks.

If it’s thought that a stone will probably be flushed out without any treatment, doctors generally recommend waiting. If the kidney stone causes pain as it travels through the ureter (tube that runs from a kidney to the bladder), painkillers like ibuprofen or diclofenac can provide relief.

Larger stones that cause problems will usually have to be broken up or surgically removed. That needs to be done if

  • the stone isn't passed within four weeks,

  • there are complications,

  • it causes severe colic (pain), or

  • the stone is larger than 10 millimeters in diameter.

Uric acid stones can sometimes be dissolved using medication.

Is medication effective for treating kidney stones?

Making it easier to pass the stone

Alpha blockers are believed to make it easier for the stones to pass out of the body. They relax the muscles in the lower part of the bladder. Alpha blockers are medications used to treat benign prostatic hyperplasia (BPH – an enlarged prostate). They have not been approved for the treatment of kidney stones. But particularly the alpha blocker tamsulosin is sometimes used off-label.

According to current research, alpha blockers can help pass stones. An analysis of 67 studies showed this to be true for kidney stones that are about 5 to 10 millimeters in diameter.

  • Without alpha blockers, the stones passed within four weeks in about 50 out of 100 people.

  • With alpha blockers, the stones passed within four weeks in about 73 out of 100 people.

Temporary side effects of alpha blockers include low blood pressure, dizziness, and tiredness. In one large study, 4 out of 100 people stopped their treatment early due to such side effects. In 5 out of 100 men, the drugs also temporarily caused retrograde ejacul*tion ("dry org*sm"). This is where no sem*n, or much less than usual, leaves the penis. Instead, the sem*n flows into the bladder.

Dissolving uric acid stones

Uric acid stones are the only type of kidney stones that can sometimes be dissolved with the help of medication. Alkaline citrate salts or sodium bicarbonate are considered for this purpose, and sometimes allopurinol. Alkaline citrate salts and sodium bicarbonate increase the pH level of the urine, and allopurinol lowers the level of uric acid. Drinking a lot of water helps to increase the effect of the medication: The more urine there is, the better the uric acids can dissolve. If you have a urinary tract infection (UTI), it isn't possible to treat the uric acid stones with medication.

If the treatment is successful, surgery isn't needed to remove the stones. But it’s not clear how effectively medication can dissolve uric acid stones. There hasn’t been any high-quality research on this.

How are kidney stones removed?

If the stones don’t pass out of the body on their own, doctors can break them up with ultrasound shock waves or remove them in a minor surgical procedure. The most suitable method will mainly depend on how big the stones are, where they are, and what they are made of.

Ultrasound shock wave therapy

In ultrasound shock wave therapy, sound waves are used to break up the stones. The stone fragments are then flushed away in the urine. This treatment is also referred to as extracorporeal shock wave lithotripsy (ESWL). A machine is used to send sound waves from outside of the body through the tissue to the stones. Shock wave therapy typically takes about 30 to 60 minutes when treating simple kidney stones (without complications). It can often be done without having to spend the night in hospital. The treatment outcome can be checked using ultrasound or x-ray scans.

Shock wave therapy is especially suitable for kidney stones that are smaller than 20 millimeters in diameter. If the stones are in the upper third of the ureter, they shouldn’t be any bigger than 10 millimeters, though.

Kidney stones: Learn More – Treatment options for kidney stones (1)

During shock wave therapy

Removing stones through an endoscopic procedure

There are two common methods for removing stones through a surgical procedure: ureterorenoscopy (URS) and percutaneous nephrolithotripsy (PCNL or PNL).

  • Ureterorenoscopy (URS): In this method, tiny instruments are moved through the urethra (the passageway that urine flows out of) and bladder with the help of an endoscope, and pushed up into the ureter where the stone is. There the stone is either broken up mechanically or using a laser so that the pieces can be flushed out in the urine or removed using the endoscope. URS is used for stones that are bigger than 10 millimeters in diameter and are in the middle or lower third of the ureter. Kidney stones up to 20 millimeters in diameter are often removed using URS.

  • Percutaneous nephrolithotripsy (PCNL): In this method, an endoscope is moved into the renal pelvis or the kidney through a small cut made on your back. There the stones can also be either broken up mechanically or with a laser. Tiny forceps are used to remove the pieces of the kidney stones. This method is mainly used to treat kidney stones greater than 10 millimeters in diameter. PCNL is now often performed as mini percutaneous nephrolithotripsy (mini PCNL). The procedure then uses a much smaller endoscope and a smaller passageway for the instruments. The stones are not removed with forceps, but rather broken up with a laser and then flushed out.

General anesthesia and a short hospital stay are necessary for both of these approaches.

Nowadays, more major surgery is only very rarely needed to remove kidney stones.

How do the advantages and disadvantages of the different treatments compare?

Various treatments can be considered for kidney stones, depending on the situation. Only the following treatments have been compared in studies, though.

Shock wave therapy and percutaneous nephrolithotripsy (PCNL) for the treatment of kidney stones

Some small studies have tested shock wave therapy and PCNL. In comparison, PCNL was more successful than shock wave therapy. The following results were observed three months after treatment:

  • 44 out of 100 people didn't have any kidney stones after having shock wave therapy.

  • 95 out of 100 people didn't have any kidney stones after having PCNL.

But the outcome of shock wave therapy depends on the size, position and composition of the kidney stones: Stones with a diameter of less than 10 millimeters are easier to break up. This is more difficult if the stones are larger or harder. Stones in the lower part of the kidney are also harder to treat with shock wave therapy.

Shock wave therapy carries the risk of leaving behind kidney stone fragments that are too big to pass through the ureter. These fragments might get stuck in the ureter on their way to the bladder. Additional treatment is then needed. To prevent this from happening, a small tube (called a ureteral stent) is sometimes temporarily placed in the ureter. The stone fragments can then flow out smoothly.

The shock waves can be painful, so painkillers are given before the treatment. They can also damage the kidney tissue, which may lead to bleeding, for example. But serious complications and long-term damage are rare.

Percutaneous nephrolithotripsy (PCNL) can also lead to bleeding. A blood transfusion may then be needed sometimes. Fever and wound infections might also occur after this operation. In rare cases, other organs may be damaged. And you have to stay in hospital for a few days too.

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CT scan

Because only a few small studies have compared these two treatments, there are no exact figures on the likelihood of complications. But shock wave therapy is still considered to be the more gentle treatment.

Shock wave therapy and ureterorenoscopy (URS) for the treatment of ureteral stones

Kidney stones that have traveled to a ureter are called ureteral stones. These stones are typically treated using shock wave therapy or endoscopic surgery through the bladder and ureter. Several studies have compared the rates of success for these two treatments when used to remove ureteral stones. The results show that most stones can be successfully treated using shock wave therapy. But the rate of success for ureterorenoscopy was slightly higher:

  • 78 out of 100 people who had shock wave therapy no longer had any kidney stones after the treatment.

  • 93 out of 100 people who had an endoscopic treatment no longer had any kidney stones afterwards.

So people are more likely to need further treatment after shock wave therapy.

The advantage of shock wave therapy is that it's less likely to lead to complications than URS is: Complications occurred in 19 out of 100 people who had endoscopic procedures, but only in 10 out of 100 people who had shock wave therapy.

The possible complications of ureterorenoscopy include bleeding and urinary tract infections (UTIs) like cystitis. The ureter may be damaged during the procedure as well. But serious complications are generally rare.

People who had shock wave therapy were much less likely to need supportive treatments afterwards, such as ureteral stents or a temporary artificial opening (stoma) in the kidney. But pain was more common during and after treatment. Bleeding and infections also seem to be more common following shock wave therapy.


  • Aboumarzouk O, M., Kata Slawomir G, Keeley Francis X et al. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev 2012; (5): CD006029. [PubMed: 22592707]

  • Aboumarzouk OM, Hasan R, Tasleem A et al. Analgesia for patients undergoing shockwave lithotripsy for urinary stones - a systematic review and meta-analysis. Int Braz J Urol 2017; 43(3): 394-406. [PMC free article: PMC5462129] [PubMed: 28338301]

  • Aboumarzouk OM, Jones P, Amer T et al. What Is the Role of alpha-Blockers for Medical Expulsive Therapy? Results From a Meta-analysis of 60 Randomized Trials and Over 9500 Patients. Urology 2018; 119: 5-16. [PubMed: 29626570]

  • Amer T, Osman B, Johnstone A et al. Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials. Arab J Urol 2017; 15(2): 83-93. [PMC free article: PMC5653615] [PubMed: 29071136]

  • Campschroer T, Zhu X, Vernooij RW et al. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev 2018; (4): CD008509. [PMC free article: PMC6494465] [PubMed: 29620795]

  • Deutsche Gesellschaft für Urologie (DGU), Arbeitskreis Harnsteine der Akademie der Deutschen Urologen. S2k-Leitlinie zur Diagnostik,Therapie und Metaphylaxe der Urolithiasis. AWMF-Registernr.: 043-025. 2018.

  • Dorantes-Carrillo LA, Basulto-Martinez M, Suarez-Ibarrola R et al. Retrograde Intrarenal Surgery Versus Miniaturized Percutaneous Nephrolithotomy for Kidney Stones >1cm: A Systematic Review and Meta-analysis of Randomized Trials. Eur Urol Focus 2022; 8(1): 259-270. [PubMed: 33627307]

  • Fankhauser CD, Kranzbühler B, Poyet C et al. Long-term Adverse Effects of Extracorporeal Shock-wave Lithotripsy for Nephrolithiasis and Ureterolithiasis: A Systematic Review. Urology 2015; 85(5): 991-1006. [PubMed: 25917723]

  • Hollingsworth JM, Canales BK, Rogers MA et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ 2016; 355: i6112. [PMC free article: PMC5131734] [PubMed: 27908918]

  • Kallidonis P, Adamou C, Ntasiotis P et al. The best treatment approach for lower calyceal stones <=20 mm in maximal diameter: mini percutaneous nephrolithotripsy, retrograde intrarenal surgery or shock wave lithotripsy. A systematic review and meta-analysis of the literature conducted by the European Section of Uro-Technology and Young Academic Urologists. Minerva Urol Nephrol 2021; 73(6): 711-723. [PubMed: 34156200]

  • Ordonez M, Hwang EC, Borofsky M et al. Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi. Cochrane Database Syst Rev 2019; (2): CD012703. [PMC free article: PMC6365118] [PubMed: 30726554]

  • Pickard R, Starr K, MacLennan G et al. Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial). Health Technol Assess 2015; 19(63): vii-viii, 1-171. [PMC free article: PMC4781616] [PubMed: 26244520]

  • Sharma G, Sharma A, Devana SK et al. Mini Versus Standard Percutaneous Nephrolithotomy for the Management of Renal Stone Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus 2022; 8(5): 1376-1385. [PubMed: 34404619]

  • Srisubat A, Potisat S, Lojanapiwat B et al. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 2014; (11): CD007044. [PubMed: 25418417]

  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Kidney stones: Learn More – Treatment options for kidney stones (2024)


Kidney stones: Learn More – Treatment options for kidney stones? ›

A kidney stone may be treated with shockwave lithotripsy, uteroscopy, percutaneous nephrolithomy or nephrolithotripsy. Common symptoms include severe pain in lower back, blood in your urine, nausea, vomiting, fever and chills, or urine that smells bad or looks cloudy.

What is the new treatment for kidney stones? ›

Extracorporeal shockwave lithotripsy (ESWL) uses high-frequency ultrasound delivered from outside the body to smash the stones into a passable dust-like material. ESWL is a major advance in the ability to deal with kidney stones. Even if smashed, larger stones create too much debris to pass through the ureter.

What is the new technique for kidney stone? ›

In a procedure for larger kidney stones called percutaneous nephrolithotomy (PCNL), surgeons make small incisions in the lower back, and then use a small camera and instruments to break up and remove the stones. Now, with a technique called "mini PCNL" or "mini perc," incisions and instruments are smaller.

What are the advancements for kidney stones? ›

Such innovations in kidney stone removal are new lasers, modern ureteroscopes, development of applications and training systems utilizing three-dimensional models, artificial intelligence and virtual reality, implementation of robotic systems, sheaths connected to vacuum devices and new types of lithotripters.

Is there a way to permanently get rid of kidney stones? ›

Percutaneous Nephrolithotomy

In this procedure, a surgeon makes a small incision, most commonly in the back, creating a narrow tunnel directly to the kidney to break up and remove large or irregularly shaped stones. Larger stones may require additional surgeries in order to completely remove them.

How did they treat kidney stones before modern medicine? ›

Many medical treatments were recommended for stone sufferers in ancient India; a vegetarian diet, a urethral syringe of medicated milk, clarified butter, or alkalis.

Is there a pill to get rid of kidney stones? ›

Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.

What calms down kidney stone pain at home? ›

Take a Warm Epsom Salt Bath. A warm bath filled with Epsom salts can be a soothing way to alleviate intense kidney pain temporarily. While it may not provide a long-term solution, the warm water and Epsom salts can help relax your muscles and ease discomfort.

Can you treat kidney stones without surgery? ›

New techniques can remove kidney stones without the need for an operation. A combination of drinking enough fluids, avoiding urinary infections, and specific treatment with medications will significantly reduce or stop new stone formation.

What is the innovative kidney stone treatment? ›

Thulium fiber laser promises simpler, easier lithotripsy

The first is a new lithotripsy platform released less than a year ago that employs a thulium fiber laser to break up kidney stones. Traditional laser lithotripters emit 12 to 120 pulses per second at the very maximum.

What is the most advanced kidney stone removal? ›

Extracorporeal shock wave lithotripsy is a technique for treating stones in the kidney and ureter that does not require surgery.

What is the new research on kidney stones? ›

Research has proved that stone growth is dependent on the urine that is supersaturated in the pelvic region. Studies has also been done to distinguish between uric acid and non-uric acid kidney stones. The results have shown that uric acid and non-uric acid stones displayed unique shapes.

What is the number 1 treatment for kidney stones? ›

Percutaneous Lithotripsy (PCNL) is the best treatment for large stones in the kidney. General anesthesia is needed to do a PCNL.

What is the new medication for kidney stones? ›

Potassium citrate (Urocit) is an investigational agent that has clinical efficacy in patients with calcium oxalate and calcium phosphate stones who are hypocitraturic. In addition, potassium citrate is an alkalinizing agent that can be used in patients with uric acid stones.

What size kidney stone requires lithotripsy? ›

The preferred treatment of >1cm stone is shockwave lithotripsy (SWL), while that of stone <2 cm is percutaneous nephrolithotomy (PCNL), but treatment of 1-2 cm renal stones is a controversial issue.

What is the best medicine to dissolve kidney stones? ›

Uric acid stones are the only type of kidney stones that can sometimes be dissolved with the help of medication. Alkaline citrate salts or sodium bicarbonate are considered for this purpose, and sometimes allopurinol.

What medication is used to flush kidney stones? ›

Your doctor may prescribe potassium citrate to help prevent kidney stones from growing larger or returning. Potassium citrate can also be used to help dissolve and prevent uric acid kidney stones.

What breakthrough treatment breaks up kidney stones with little to no pain? ›

What is extracorporeal shock wave lithotripsy? Extracorporeal shock wave lithotripsy is a technique for treating stones in the kidney and ureter that does not require surgery. Instead, high energy shock waves are passed through the body and used to break stones into pieces as small as grains of sand.

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