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Kidney Stones: When to Wait and When to Operate?

When to Wait and When to Operate? Kidney Stones

Kidney stones are known to cause some of the most intense pain a person can experience. The pain strikes suddenly, travels in waves, and leaves most people unable to sit still. However, not every kidney stone requires surgical treatment. Some pass naturally, while others demand urgent medical care.

Two of the most common questions patients ask are:
“Doctor, can my stone pass on its own?” and “When is surgery absolutely necessary?”

This blog simplifies the decision-making process by explaining when to wait, when to intervene, and what today’s urological guidelines recommend.

What Exactly Is a Kidney Stone?

Imagine your kidney as a water filter for your body. It removes waste and minerals from your blood and sends them out through urine. Sometimes, these minerals—like calcium, uric acid, and oxalate—stick together instead of dissolving. Over time, they harden and form a small stone.

What Exactly Is a Kidney Stone?

The most common types include calcium oxalate, uric acid, phosphate stones, and infection-related struvite stones. Stones may remain inside the kidney or move into the ureter, the narrow tube connecting the kidney to the bladder. When they get lodged here, pain often becomes severe.

What are Some Symptoms You Should Not Ignore

Kidney stone pain is usually very distinct. People describe it as:

  • Sudden, sharp pain in the side or back
  • Pain that comes and goes in waves
  • Pain radiating to the lower abdomen or groin
  • Nausea or vomiting with the pain
  • Burning while passing urine
  • Blood in urine (sometimes visible, sometimes detected in tests)

But the most important warning symptom is: Fever with pain — this is dangerous. It means an infection is trapped behind a blocked kidney, and bacteria can quickly spread into the bloodstream causing sepsis.

A Simple Guide to When Kidney Stones Can Pass on Their Own

Some kidney stones don’t need immediate surgery. Very small stones, usually 4 mm or less, often pass out naturally, especially if they’re located lower in the ureter or near the bladder. In such cases, doctors may advise a “wait and watch” approach. This is only safe when there’s no fever, kidney function is normal, pain can be controlled with medication, and there is just one stone. During this period, patients are usually given painkillers, asked to drink plenty of water, and sometimes prescribed medicines like tamsulosin to relax the ureter and help the stone move.

Kidney Stones- When to Wait and When to Operate?

However, waiting isn’t always safe. You should not delay treatment if there is fever, unbearable pain, repeated vomiting, dehydration, or signs like hydronephrosis (kidney swelling on ultrasound). Larger stones — generally above 6 mm — rarely pass on their own. The same applies if you have a single functioning kidney, rising creatinine levels, or a stone that has been stuck for more than 2–3 weeks, as this can lead to permanent damage. In these situations, waiting can be dangerous, and immediate treatment is important.

When a stone is too large, refuses to move, or begins affecting kidney health, surgery becomes the safest and most effective choice. The type of procedure depends on the stone’s size, location, hardness, and the symptoms it’s causing, ensuring fast relief and protection of kidney function.

Types of Stone Surgeries Available

Modern urology offers several minimally invasive procedures that ensure quick recovery and excellent outcomes.

Kidney Stones

1. RIRS (Retrograde Intrarenal Surgery)

Ideal for stones up to around 2 cm located in the kidney or ureter. A thin, flexible scope is introduced through the natural urinary passage, and a laser breaks the stone into fine dust that exits naturally. This procedure involves no cuts, minimal pain, and quick discharge.

2. URS (Ureteroscopy)

Best suited for stones stuck in the ureter. A scope is passed into the ureter, the stone is fragmented with a laser, and the fragments are removed. A temporary stent may be placed for comfortable drainage and removed after a short period.

3. PCNL (Percutaneous Nephrolithotomy)

The preferred treatment for stones larger than 2 cm, multiple stones, or complex staghorn stones. Through a small incision (around 1 cm) in the back, instruments enter the kidney to remove the stone completely. Modern variations — Mini PCNL, Ultra Mini PCNL, and Micro PCNL — use even smaller instruments for faster healing.

4. ESWL (Shock Wave Therapy)

A non-invasive option for very small kidney stones. Shock waves are applied from outside the body to break the stones. However, this works best for softer stones and is not ideal for hard stones, obese patients, or stones located in the lower ureter.

Preventing Stones from Coming Back

Prevention is crucial because kidney stones tend to recur. Drinking 2.5–3 litres of water daily, especially in hot climates like Mumbai, helps keep urine diluted. Reducing salt, limiting oxalate-rich foods like spinach and nuts, managing weight, avoiding excessive Vitamin C, and cutting down on red meat can all reduce risk. Patients with recurrent stones may need a 24-hour urine test for metabolic evaluation.

Frequently Asked Questions

1. Can drinking more water dissolve stones?

Water helps flush small stones but does not dissolve most varieties.

2. Are all stones treated with laser surgery?

Many are, but very large stones require PCNL for complete clearance.

3. Is stone surgery painful?

Modern minimally invasive techniques ensure quick healing and minimal discomfort.

4. Do stones come back?

Modern minimally invasive techniques ensure quick healing and minimal discomfort.

5. What is the recovery time?

Modern minimally invasive techniques ensure quick healing and minimal discomfort.

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