Treating kidney and ureteric stones does not always mean surgery. The decision depends on the stone’s size and position, how bad the pain is, any infection or blockage, and the patient’s health. This page summarises the options in UK NICE and European Association of Urology guidelines; the doctor chooses with the patient after assessment.
Medically reviewed by Prof. Dr. Samir Ahmed Al-Samarrai, consultant urologist. Last reviewed:
First: pain relief
NICE recommends NSAIDs as first-line treatment for renal colic, then intravenous paracetamol if NSAIDs are unsuitable, and stronger painkillers only when both are not enough. It does not recommend antispasmodics. The doctor checks kidney function and the stomach before choosing a painkiller.
Second: waiting for the stone to pass
- Stones smaller than about 5 mm usually pass on their own, and small symptom-free kidney stones can be monitored.
- Alpha-blockers such as tamsulosin may help lower ureteric stones under 10 mm pass.
- Keep a passed stone for analysis if possible.
When does a stone need removing?
- Ongoing pain the patient cannot tolerate, or a stone unlikely to pass.
- A stone that has not passed after enough time.
- A blocked kidney or reduced kidney function.
- Infection with blockage: needs urgent drainage of the kidney with a stent or a tube through the skin, then stone treatment later.
- Large or growing kidney stones.
Options by stone size and position (NICE, adults)
| Stone | First choice | Alternatives |
|---|---|---|
| Kidney, under 10 mm | Shockwave lithotripsy | Ureteroscopy if shockwave is unsuitable or fails |
| Kidney, 10 to 20 mm | Ureteroscopy or shockwave lithotripsy | Percutaneous nephrolithotomy if both fail |
| Kidney, over 20 mm | Percutaneous nephrolithotomy | Ureteroscopy if it is not an option |
| Ureter, under 10 mm | Shockwave lithotripsy | Ureteroscopy if not cleared within 4 weeks or shockwave is unsuitable |
| Ureter, 10 to 20 mm | Ureteroscopy | Shockwave lithotripsy in selected cases |
Choices also depend on stone type and density, kidney anatomy and the patient’s medicines, so the doctor decides what suits each case.
Removal methods
- Extracorporeal shockwave lithotripsy: no cut; fragments pass in the urine over days to weeks.
- Ureteroscopy with laser: through the urethra with no external cut, including flexible ureteroscopy to reach inside the kidney.
- Percutaneous nephrolithotomy: through a small opening in the back for large stones, including mini techniques.
- Stents: not placed routinely after every ureteroscopy; used when needed.
After treatment
Mild pain, burning or a little blood in the urine for a few days is common. See a doctor urgently with fever, severe pain or inability to pass urine. Prevention of recurrence comes next. Read kidney stones and prevention.
Articles on stone treatment
Frequently asked questions
Does every stone need surgery?
No. Most stones smaller than about 5 mm pass on their own, and alpha-blockers can help some lower ureteric stones up to 10 mm pass. Removal is discussed for larger stones, ongoing pain, infection or a blocked kidney.
What is the difference between shockwave and endoscopic treatment?
Shockwave lithotripsy works from outside the body without a cut and suits many stones under 2 cm. Ureteroscopy passes through the urethra into the ureter or kidney and breaks the stone with a laser; it suits ureteric stones and many kidney stones.
How are large stones treated?
Kidney stones larger than 2 cm are usually treated with percutaneous nephrolithotomy, through a small opening in the back, according to NICE and European guidelines.
Will I need a stent after treatment?
Not always. NICE advises against routinely placing a stent after ureteroscopy for ureteric stones under 2 cm, but one may be needed with infection, obstruction, a single kidney or when further treatment is planned.
What is the best painkiller for renal colic?
NICE recommends NSAIDs first, then intravenous paracetamol if NSAIDs are unsuitable, and stronger painkillers only when both are not enough, after the doctor checks kidney function and the stomach.
Sources
Book a consultation
Prof. Al-Samarrai and Dr. Amer Mousa assess kidney and ureteric stones and choose the right treatment with you at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
This information is for health education and does not replace a medical examination. See our medical content policy.