How Are Kidney Stones Removed? Common Treatment Options Explained

Kidney stones can be removed or broken into smaller pieces using several techniques. Common options include shock wave lithotripsy (SWL), ureteroscopy with laser lithotripsy and percutaneous nephrolithotomy (PCNL).

Shock wave lithotripsy (SWL) uses shock waves delivered from outside the body to break a kidney stone into smaller fragments. These fragments can then pass through the urinary tract in the urine. As it does not require an incision or the insertion of instruments into the urinary tract, SWL may be suitable for selected kidney or ureteral stones.

Ureteroscopy involves passing a thin scope through the urethra and bladder to reach a stone in the ureter or kidney, without making an external incision. The stone can then be broken into smaller fragments using laser energy, with pieces removed using specialised instruments or left small enough to pass naturally.

Percutaneous nephrolithotomy (PCNL) is generally used for larger or more complex kidney stones that may be difficult to clear effectively with other methods. A small incision is made in the back to create a direct tract into the kidney, through which a nephroscope and specialised instruments are used to break up and remove the stone.

Most kidney stones that require intervention can be treated with SWL, ureteroscopy or PCNL. More invasive surgery is now uncommon, but may be considered in selected complex cases where these approaches are unsuitable or have not been successful.

Laparoscopic or robotic surgery may occasionally be considered when a stone cannot be managed effectively using standard endoscopic or percutaneous techniques, particularly when other anatomical or urinary tract issues also need to be addressed. These procedures use small incisions to access the affected area and are not routinely used for kidney stone removal.

Open surgery accesses the kidney or urinary tract through a larger incision and is rarely required for kidney stone removal today. It may be considered in exceptional cases where less invasive techniques are not suitable or where complex anatomy makes another approach impractical.

How the stone is affecting the urinary tract also influences treatment. Persistent pain or urinary obstruction may make active removal more appropriate, while an associated urinary infection may need to be treated before definitive stone removal can safely proceed.

A urologist will also consider the patient's overall health and suitability for different procedures. The likelihood of clearing the stone is weighed against factors such as procedural risks, recovery and the possibility that more than one treatment session may be needed.

Choosing a kidney stone treatment starts with understanding the stone itself and how it is affecting the urinary tract. Imaging and other investigations can help establish its size and location, assess for obstruction or infection, and determine whether the stone can be monitored or would be better treated with a removal procedure.

At Tan Urology, patients can receive assessment and treatment for kidney stones, including non-invasive and minimally invasive options where suitable. Dr Lincoln Tan assesses the characteristics of each stone alongside the patient's clinical condition to determine an appropriate management approach. Book an appointment to have your kidney stone assessed and discuss which treatment options may be suitable for you.