Observation plus medicine
Small, distal stones with a working kidney and no infection. Pain control, fluids, and sometimes an alpha blocker. Repeat imaging confirms the stone is gone, not just quiet.
When home fails
Medical and surgical treatment
A urologist chooses a tool based on stone size, hardness, location, your anatomy, and whether the kidney is infected or blocked. NIDDK describes the main options below. None of them replace prevention afterward — fragments and dust still want to become the next stone.
Shock wave lithotripsy (SWL)
External shock waves break a stone into pieces you then pass. Outpatient. Best for stones in the kidney or upper ureter that are not too hard or too large. You still need a strainer. Bruising and a few days of gravel are common.
Ureteroscopy
A thin scope goes through the urethra and bladder into the ureter. The stone is basketed out or lasered. Same-day surgery for most people. A temporary stent is common; stent symptoms (urgency, flank twinges with voids) are miserable and expected. Know the removal plan before you leave.
Percutaneous nephrolithotomy (PCNL)
A small tract through the back into the kidney for large or staghorn stones. Hospital stay is typical. This is the option when shock waves and a ureteroscope cannot clear the burden.
Dissolution therapy
Uric acid stones can sometimes be dissolved by raising urine pH with prescription alkali. Calcium stones do not dissolve with lemonade at kitchen doses. Anyone promising a “natural lithotripsy drink” is selling hope, not mineralogy.
After the procedure
- Ask for the stone analysis.
- Schedule a 24-hour urine once you have healed and are eating normally.
- Treat the stent as a known misery with an end date, not a mystery complication.
- Restart the prevention stack the week you can drink freely again.