Kidney Stone Treatment (URS, RIRS, PCNL & ESWL)
Ways to remove kidney and ureteric stones without open surgery — a laser through the natural urine passage, a small keyhole in the back, or shock waves from outside the body — chosen to suit the size, position and hardness of your stone.
अपॉइंटमेंट बुक करें या आपातकाल में अभी कॉल / WhatsApp करें।
30 minutes – 2 hours
Day care to 3 days
Spinal or general
About 3–7 days
Overview
Kidney stone pain is often described as the worst pain a person has felt — a sudden, gripping ache in the back or side that travels to the groin, often with vomiting and sometimes blood in the urine. For others, a stone is found by chance on an ultrasound done for something else. Either way, the first questions are the same: will it pass on its own, and if not, what is the gentlest way to remove it?
Stones form when salts such as calcium oxalate or uric acid crystallise in concentrated urine. Our hot summers, low water intake and diet make them common in the Braj region. Many stones smaller than about 5 mm pass on their own with plenty of fluids and medicines within a few weeks. Larger stones, or stones that block the flow of urine, cause infection or keep causing pain, usually need to be removed.
Kidney stone treatment today rarely needs an open operation. In URS and RIRS, a thin telescope passes up the natural urine passage to the stone, which is broken with a laser — there is no cut at all. PCNL reaches large kidney stones through a keyhole of about 1 cm in the back. ESWL uses focused shock waves from outside the body to break suitable stones into fragments that pass in the urine.
At SKS Hospital, our urology team offers all four methods, backed by CT and ultrasound imaging, laboratory, operation theatres, ICU and 24×7 emergency care on the same campus. We explain which option suits your stone and why, how long you will stay, whether a temporary stent will be needed, and how to lower the chance of new stones forming.
Why it's done
A procedure is advised when a stone is unlikely to pass on its own, or when waiting would put your kidney or your health at risk. Common reasons include:
- A stone larger than about 6 mm in the ureter, or larger than about 5–10 mm in the kidney, that is unlikely to pass
- Severe or repeated pain that is not controlled with medicines
- A stone blocking urine flow and causing swelling of the kidney (hydronephrosis)
- Urine infection or fever along with a blocked kidney — an emergency needing urgent drainage
- A stone that has not moved after 4–6 weeks of medicines and fluids
- Stones in a single working kidney, in both kidneys, or with falling kidney function
Is it right for you?
Usually a good fit
- A stone that is too large to pass, or has stayed in one place despite medicines
- A stone causing repeated pain, bleeding, infection or blockage of the kidney
- You are fit for a short spinal or general anaesthetic
- You are able to return for follow-up and stent removal when advised
May not be suitable
- A small stone (usually under 5 mm) with no infection or blockage — a trial of fluids and medicines often comes first
- An active, untreated urine infection — this must be treated or the kidney drained first
- Pregnancy — ESWL and X-ray-guided procedures are avoided, and a temporary stent or drainage tube is often used until after delivery
- Blood thinners that cannot safely be paused or an uncorrected bleeding disorder — PCNL and ESWL are usually avoided, and RIRS may be chosen instead
Types and techniques
URS — ureteroscopy with laser
A thin, semi-rigid telescope is passed through the urethra and bladder into the ureter, the tube that carries urine from the kidney to the bladder. The stone is broken with a laser and the pieces are removed with a tiny basket or left as fine dust to wash out. URS is usually the first choice for stones stuck in the ureter, and there is no cut.
RIRS — flexible laser surgery inside the kidney
Retrograde intrarenal surgery uses a flexible telescope that bends to reach every part of the kidney through the natural passage. It usually suits kidney stones up to about 2 cm, lower-pole stones that ESWL often cannot clear, and patients in whom a keyhole in the back is less safe. Very large stones may need a second sitting.
PCNL — keyhole surgery through the back
Percutaneous nephrolithotomy is usually preferred for kidney stones larger than about 2 cm, branching (staghorn) stones and very hard stones. A keyhole of about 1 cm is made in the back under X-ray or ultrasound guidance, and the stone is broken and removed through it, often clearing a large stone in one sitting. The hospital stay is usually 2–3 days.
ESWL — shock-wave lithotripsy
Shock waves focused from outside the body break the stone while you lie on a special table, usually with painkillers or light sedation and no anaesthetic. It suits softer kidney stones up to about 1–1.5 cm and some upper ureteric stones. It is a day-care treatment, but more than one session may be needed and the fragments take days to weeks to pass.
Preparing for the procedure
- A CT KUB scan (usually without dye) or ultrasound to show the exact size, position and density of the stone, along with urine routine and culture
- Blood tests for kidney function, blood count, sugar and clotting; an ECG and a check-up by the anaesthetist if you are over 40 or have other health conditions
- Any urine infection is treated with antibiotics first — if the kidney is blocked and infected, it is drained with a stent or tube before the stone is treated
- Aspirin, clopidogrel, warfarin or newer blood thinners may need pausing — only on the advice of your urologist and the doctor who prescribed them
- Do not eat for about 6 hours before the procedure; tell us if you are or could be pregnant, or have had a reaction to X-ray dye
- Bring previous scans and reports, any stone you have passed before, your list of medicines and one family member
The procedure, step by step
Anaesthesia and positioning
You are given spinal anaesthesia, which numbs you from the waist down, or a general anaesthetic, so you feel no pain. For URS and RIRS you lie on your back with your legs supported; for PCNL you usually lie on your front. ESWL needs no anaesthetic — you lie on the lithotripsy table with painkillers.
Reaching the stone
For URS and RIRS, the urologist passes the telescope through the urethra and bladder up to the stone, watching on a screen. For PCNL, a fine needle is guided into the kidney through the back using X-ray or ultrasound, and the track is gently widened to about 1 cm. For ESWL, the stone is located with X-ray or ultrasound and the shock waves are focused on it.
Breaking and removing the stone
A laser fibre breaks the stone into small fragments or fine dust, and larger pieces are pulled out with a tiny basket or washed out through the PCNL sheath. During ESWL you feel a repeated tapping in the back for about 45–60 minutes. Fragments are sent to the laboratory to find out what the stone is made of.
Stent, tube and finishing
After URS or RIRS, a soft plastic tube called a DJ stent is often left between the kidney and bladder for 1–3 weeks to let swelling settle and fragments pass. A urine catheter is usually kept overnight, and after PCNL a small drainage tube may stay in the back for a day or two. URS usually takes 30–60 minutes, RIRS 45–90 minutes and PCNL 1–2 hours.
Benefits and risks
Benefits
- No large cut — URS, RIRS and ESWL leave no wound, and PCNL needs only a 1 cm keyhole
- Relief from stone pain and protection of the kidney from long-term damage caused by blockage
- A short hospital stay — often one night for URS or RIRS, and same-day discharge for ESWL
- Stone analysis after removal guides diet and medicines to help prevent new stones
Possible risks
- Blood-tinged urine and burning while passing urine for a few days, which is common and usually settles on its own
- Discomfort from the DJ stent — frequent urination, urgency and a dull ache in the side when passing urine — until it is removed
- Urine infection or fever after the procedure; a serious blood infection (urosepsis) is uncommon but needs urgent treatment
- Leftover fragments needing a second procedure, which is more likely with very large stones or after ESWL
- Rarely, injury to the ureter, or bleeding needing a blood transfusion after PCNL in a few patients in 100; injury to nearby organs is very rare
Recovery timeline
The first day
You can usually eat and drink a few hours after the procedure. Some burning and pink urine are normal. The catheter is usually removed the next morning. Most patients go home within 24 hours after URS or RIRS, the same day after ESWL, and in 2–3 days after PCNL.
Days 2 to 7
Drink enough water to keep your urine pale — often around 2.5–3 litres a day unless your doctor advises otherwise. Take the prescribed painkillers and antibiotics. Most people return to light work and daily activities within 3–7 days; after PCNL, avoid heavy lifting for about 2 weeks.
Stent removal in 1 to 3 weeks
If a DJ stent was placed, it is removed in a short OPD or day-care procedure, usually with a thin telescope and local anaesthetic jelly. A stent must never be forgotten — if left for many months it can become coated with stone and block. Keep your stent removal date written on your discharge card.
The months ahead
A follow-up ultrasound or X-ray confirms that the kidney is clear. About half of people who have had one stone form another within 5–10 years if nothing changes, so we explain your stone analysis report, the diet and fluid changes that suit your stone type, and when to repeat the scan.
When to call your doctor
- Fever above 100.4°F (38°C), shivering or chills — this can mean infection behind a blocked kidney and needs emergency care
- Being unable to pass urine, or passing very little urine
- Severe pain in the back or side that is not relieved by the prescribed painkillers, or repeated vomiting
- Heavy bleeding in the urine with clots, or urine that stays dark red
- Bleeding, swelling or urine leaking from the PCNL wound or drain site
Call us on +91 86799 11029 or come straight to our 24×7 emergency department.
Alternatives
Fluids and medicines to help the stone pass
Many stones under about 5 mm pass on their own in a few weeks. Plenty of water, painkillers and a medicine such as tamsulosin that relaxes the ureter can help. We monitor with repeat scans, and a procedure is advised if the stone does not pass, pain continues or infection develops.
Medicines to dissolve uric acid stones
Uric acid stones — which do not show on a plain X-ray — can sometimes be dissolved over weeks to months with medicines that make the urine less acidic, such as potassium citrate, along with diet changes. Other stone types, including the common calcium stones, do not dissolve.
Laparoscopic or open surgery
Very rarely, for unusually large or complex stones, or when the kidney has an abnormal shape or a narrowing that also needs repair, keyhole (laparoscopic) or open surgery may be advised. Your urologist will explain why if this is the better choice.
This page explains Kidney Stone Treatment (URS, RIRS, PCNL & ESWL) in general terms. Your doctor will advise what is right for you after examining you and reviewing your reports. Please read our medical disclaimer.
Ask about your options, the cost and your insurance before you decide. We are empanelled with major insurers and TPAs.
Your care team
Urology Department
Kidney stone treatment at SKS Hospital is carried out by our urology team with trained theatre nurses, anaesthetists and imaging support, backed by the laboratory, ICU, blood bank and 24×7 emergency department on the same campus on NH-19 (old NH-2), Mathura.
From the first emergency visit for stone pain or a planned OPD consultation, to the procedure, stent removal and prevention advice, the same team stays with you — and our nephrology colleagues help when stones affect kidney function or keep coming back.
Other departments involved
Related procedures
Prostate Surgery (TURP)
TURP removes the part of an enlarged prostate that blocks urine flow, through the urethra and without an external cut.
Dialysis
Blood purification for kidney failure, supervised by our nephrologists, with scheduled sessions and emergency dialysis on the same campus.
Laparoscopic Gallbladder Surgery
Keyhole removal of the gallbladder for gallstones, a different kind of stone that causes pain in the upper abdomen.
Cystoscopy
A thin telescope passed into the bladder to check for stones, tumours or blockage, and to remove DJ stents after stone surgery.
CT KUB Scan
A quick, usually dye-free CT scan of the kidneys, ureters and bladder that shows the exact size and position of stones.
Urethroplasty
Reconstructive surgery that repairs a narrowed urethra (stricture) and restores a normal, strong urine stream for the long term.
Frequently Asked Questions
Common questions patients and families ask us about kidney stone treatment.
Which treatment suits my stone?
It depends on the size, position and hardness of the stone, and on your health. As a general guide, URS suits stones in the ureter, RIRS or ESWL suit kidney stones up to about 1.5–2 cm, and PCNL suits stones larger than about 2 cm. Your urologist will explain the choice after reviewing your CT scan.
Will there be a cut or stitches?
URS, RIRS and ESWL leave no wound at all, because the telescope passes through the natural urine passage or the shock waves act from outside. PCNL needs a keyhole of about 1 cm in the back, which heals within a week or two and usually leaves only a small mark.
Is the procedure painful?
You will not feel pain during URS, RIRS or PCNL because of the anaesthesia. ESWL feels like a repeated tapping or flicking in the back and is managed with painkillers. Afterwards, mild pain, burning and pink urine for a few days are common and settle with medicines.
What is a DJ stent and why do I need one?
A DJ stent is a soft, thin plastic tube placed inside, between the kidney and the bladder. It keeps urine draining while swelling settles and fragments pass. You cannot see it from outside. It usually stays for 1–3 weeks and is removed in a short procedure — it must not be left in longer than advised.
Can stones be dissolved with medicines, home remedies or beer?
Only uric acid stones can sometimes be dissolved with medicines. Calcium stones, the most common type, do not dissolve with any remedy. Beer does not dissolve stones and can dehydrate you. Plenty of water helps small stones pass, but larger or blocking stones need treatment.
Will the stone come back?
Stones can recur — about half of people form another within 5–10 years without changes. Drinking enough water to keep urine pale, reducing salt, packaged food and excess meat, and following the diet advice based on your stone analysis all lower the risk. A yearly ultrasound helps catch new stones early.
Can kidney stones be treated during pregnancy?
Most stones in pregnancy are managed with fluids and pain relief. If a stone blocks the kidney or causes infection, a temporary stent or drainage tube is usually placed, and definitive treatment is often planned after delivery. ESWL and X-ray-guided PCNL are avoided in pregnancy. Our urology and obstetrics teams plan care together.
When should I come to emergency with stone pain?
Come straight to emergency or call +91 86799 11029 if stone pain comes with fever or chills, if you cannot pass urine, if vomiting stops you keeping fluids down, if the pain is not controlled by painkillers, or if you have only one kidney. An infected, blocked kidney needs urgent drainage.
How much does kidney stone treatment cost, and is it covered by insurance?
The cost depends on the method, the number of sittings, whether a stent is needed and the length of stay. Our team gives a written estimate before a planned procedure. SKS Hospital is empanelled with major insurers and TPAs, and stone treatment is usually covered — our insurance desk helps with pre-authorisation.
Book a consultation at SKS Hospital
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