Kidney Stone Treatment (RIRS, PCNL & ESWL)
Renal colic is often described as the worst pain a person can experience — and the stone causing it can almost always be removed without a single external cut. Our urologists select between laser RIRS, mini-PCNL and shockwave lithotripsy based on your stone's size, position and hardness on CT. Most patients go home within 24 hours, with cashless insurance and full stone-analysis follow-up so it does not happen again.
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What is Kidney Stones?
Kidney stones are hard crystalline deposits that form inside the kidney when the urine becomes concentrated enough for dissolved salts to crystallise out and clump together. They are extremely common in India — the northern and western states form part of a recognised global "stone belt", where a hot climate, heavy fluid loss through sweat and often inadequate water intake combine to keep urine persistently concentrated.
A stone sitting quietly inside the kidney frequently causes no symptoms at all. The trouble starts when it moves into the ureter, the narrow tube carrying urine down to the bladder. The ureter is only three to four millimetres wide, and a stone lodging in it obstructs the flow. Urine continues to be produced, pressure builds behind the blockage, and the ureter goes into violent waves of spasm trying to push the stone along. That is renal colic: severe, cramping pain in the flank that comes in waves, often radiating down to the groin, typically with nausea and vomiting, and characteristically with the patient unable to find any position that helps. It is the restlessness that distinguishes it — someone with peritonitis lies very still, while someone with renal colic cannot keep still at all.
Not all stones are the same, and the difference matters for treatment. Around 80% are calcium oxalate, which are hard and resist shockwaves. Uric acid stones are radiolucent — invisible on plain X-ray — and are the one type that can genuinely be dissolved with medication that alkalinises the urine. Struvite stones form in the presence of infection, can grow very large into a staghorn shape filling the kidney's collecting system, and must be removed completely because any fragment left behind harbours bacteria. Cystine stones are rare, inherited and recur persistently.
Size and position determine what happens next. Stones under 5 mm pass spontaneously in around 80% of cases with fluids, painkillers and medical expulsive therapy. Between 5 and 10 mm, roughly half pass. Above 10 mm, spontaneous passage is unlikely and intervention is usually needed. Position matters too — a stone in the lower pole of the kidney drains against gravity and clears poorly after shockwave treatment, which is why RIRS is often preferred there.
Two situations are genuine emergencies rather than matters for elective planning. An obstructed kidney with infection — fever and rigors alongside the colic — is a urological emergency that needs urgent drainage, because sepsis can develop within hours. And a completely obstructed kidney left untreated for several weeks can lose function permanently, sometimes silently, since a blocked kidney may stop hurting once it stops producing urine.
Finally, treating the stone is only half the job. The recurrence rate is around 50% within five to ten years if nothing changes. That is why stone analysis, a metabolic workup and a personalised fluid and dietary plan are part of the treatment rather than an afterthought.
Treatment information
| Condition | Renal & Ureteric Calculi (Kidney Stones) |
|---|---|
| Procedure | RIRS / Mini-PCNL / URSL / ESWL |
| Duration | 30 to 90 minutes |
| Treated by | Urologist |
| Anaesthesia | Spinal or general anaesthesia |
| Success rate | 90–98% stone-free depending on technique and stone size |
| Recovery time | 2 to 7 days |
| Hospital stay | Daycare to 2 days |
Signs you may need Kidney Stones treatment
- Severe cramping pain in the flank or side, coming in waves
- Pain radiating down towards the groin, testicle or labia as the stone descends
- Restlessness — an inability to find any comfortable position
- Nausea and vomiting accompanying the pain
- Blood in the urine, either visible or detected on testing
- Burning or pain while passing urine
- An urgent, frequent need to pass urine, especially as the stone nears the bladder
- Cloudy or foul-smelling urine, suggesting infection
- Fever and chills — this combination with colic is an emergency
- Passing gravel or small stone fragments in the urine
- Often no symptoms at all when the stone is sitting quietly inside the kidney
What causes it?
- Inadequate fluid intake, leaving the urine persistently concentrated
- High dietary salt, which increases calcium excretion into the urine
- High intake of animal protein, raising uric acid and lowering urinary citrate
- Oxalate-rich diet — excess spinach, beetroot, nuts, tea and chocolate
- Low dietary citrate, the body's natural inhibitor of stone formation
- Recurrent urinary tract infection, which produces struvite stones
- Metabolic conditions: hyperparathyroidism, gout, renal tubular acidosis
- Inflammatory bowel disease or previous bowel surgery, which increases oxalate absorption
- Structural abnormalities that obstruct drainage, such as PUJ obstruction or a horseshoe kidney
- Certain long-term medications and excessive vitamin C or calcium supplementation
Who is more likely to be affected
- Living or working in a hot climate with heavy sweating
- A previous kidney stone — the strongest single predictor of another
- Family history of stone disease
- Male sex, though the gap has narrowed considerably
- Obesity, type 2 diabetes and metabolic syndrome
- Occupations with limited access to water or toilets — drivers, field staff, surgeons, teachers
- Gout or a high serum uric acid
- Long-term immobilisation
When to see a doctor immediately
- Severe flank pain that comes in waves and does not settle with simple painkillers
- Fever or chills alongside flank pain — go to hospital the same day, this can be sepsis
- Visible blood in the urine
- Vomiting that prevents you keeping fluids down
- Complete inability to pass urine
- Pain in a solitary kidney, or in a transplanted kidney
- Pain during pregnancy, which needs specialist assessment and ultrasound rather than CT
- A known stone that has been growing on successive scans, even without symptoms
How it is diagnosed
Non-contrast CT KUB
The definitive test, and the one that decides the treatment. It detects almost every stone regardless of type, gives the exact size, position and — through the Hounsfield density — the hardness. A dense stone above roughly 1000 HU resists shockwaves, so this single number frequently determines whether ESWL is worth attempting at all.
Ultrasound KUB
First-line in pregnancy and in children, and useful for follow-up because it involves no radiation. It reliably shows hydronephrosis — swelling of the kidney from obstruction — and stones within the kidney, but it misses many stones in the middle part of the ureter.
Urine analysis and culture
Detects blood, crystals and infection. A positive culture must be treated before any stone procedure, because instrumenting an infected system can precipitate sepsis.
Blood tests
Kidney function, calcium, uric acid, phosphate and electrolytes. A raised calcium prompts a parathyroid hormone check, since undiagnosed hyperparathyroidism is a treatable cause of recurrent stones that is easy to miss.
Stone analysis
The retrieved stone or its fragments are sent for compositional analysis. This is the step most often skipped and most worth doing — the composition dictates the entire prevention strategy, and without it advice is guesswork.
24-hour urine metabolic workup
Advised for recurrent stone formers, patients with a single kidney, children, and anyone with a strong family history. It measures volume, calcium, oxalate, citrate, uric acid, sodium and pH over a full day to identify the specific abnormality driving stone formation.
How the options compare
| Feature | ESWL (Shockwave) | RIRS (Laser) |
|---|---|---|
| Access | Entirely external, no instrument enters the body | Through the natural urinary passage, no cut |
| Anaesthesia | Sedation or none | Spinal or general |
| Best stone size | Under 10 mm | Up to 20 mm |
| Hard stones (>1000 HU) | Often fails | Effective regardless of hardness |
| Lower pole stones | Poor clearance — fragments do not drain | Good, the scope reaches directly |
| Stone-free rate | 60–80%, often needs repeat sessions | 90–95% in a single session |
| DJ stent needed | Usually not | Usually yes, for 1–2 weeks |
| Hospital stay | Daycare | Daycare or one night |
| Return to work | 1–2 days | 2–4 days |
Types of treatment
Conservative management
Watchful waiting with high fluid intake
Appropriate for stones under 5 mm in the ureter, around 80% of which pass on their own. It means 3 to 4 litres of water a day, strong painkillers on hand, and straining the urine to catch the stone so it can be sent for analysis.
Medical expulsive therapy
An alpha-blocker such as tamsulosin relaxes the smooth muscle of the lower ureter, improving the chance of passage and reducing the number of pain episodes. Most useful for stones in the lower third of the ureter.
Dissolution therapy for uric acid stones
Uric acid stones are uniquely dissolvable. Alkalinising the urine with potassium citrate to a pH of 6.5–7, together with high fluid intake and sometimes allopurinol, can genuinely dissolve them over weeks — no procedure required. This does not work for any other stone type.
Pain control
Anti-inflammatory injections are more effective than opioids for renal colic because they reduce the ureteric spasm and the pressure behind the obstruction, rather than simply blunting the pain signal.
Procedures for stone removal
ESWL — extracorporeal shockwave lithotripsy
Focused shockwaves generated outside the body break the stone into fragments that then pass in the urine. Completely non-invasive, needs little or no anaesthesia, and is done as a daycare session. Best for softer stones under 10 mm in the kidney or upper ureter, and unsuitable for very hard stones or lower pole stones that will not drain.
RIRS — retrograde intrarenal surgery
A flexible scope is passed up through the urethra, bladder and ureter into the kidney itself, and a holmium laser fragments or dusts the stone. There is no external cut of any kind. Excellent for stones up to 20 mm, for hard stones and for lower pole stones, and it is the technique of choice for patients on blood thinners or with a single kidney.
URSL — ureteroscopic laser lithotripsy
A rigid or semi-rigid scope reaches a stone lodged in the ureter and the laser fragments it, with fragments retrieved by basket in the same sitting. Stone-free rates for ureteric stones are the highest of any technique, above 95%.
Mini-PCNL and standard PCNL
For large or staghorn stones. A small tract of a few millimetres is made through the flank directly into the kidney under imaging guidance, and the stone is fragmented and removed through it. It is the only technique that reliably clears very large stone burdens in one sitting. Mini-PCNL uses a smaller tract with less bleeding and a quicker recovery.
DJ stent placement
A soft internal tube from kidney to bladder that keeps urine draining. Placed as an emergency measure in an obstructed infected kidney, or routinely after RIRS to prevent post-operative colic from swelling. It causes some urinary urgency and mild discomfort, and is removed after one to two weeks in a brief office procedure.
Emergency drainage
When an obstructed kidney is infected, the priority is drainage rather than stone clearance — either a DJ stent or a percutaneous nephrostomy tube through the back. The stone is dealt with only after the infection has been treated. Getting this order right is what prevents sepsis.
What happens, step by step
- 1
Assessment and imaging
Same day for acute pain- Pain is controlled first, usually with an anti-inflammatory injection
- A non-contrast CT KUB establishes size, position and hardness of the stone
- Urine culture, kidney function and calcium are checked
- Infection is identified early, because it changes the plan entirely
- 2
Choosing the technique
20–30 minutes- The urologist explains why one approach suits your stone over another
- Stone density on CT decides whether shockwaves will work at all
- Lower pole position, hardness and size push the decision towards RIRS or PCNL
- You are told clearly whether a DJ stent will be needed, and for how long
- 3
Admission and preparation
30–60 minutes- Admission on the morning of the procedure in most cases
- Any urinary infection must already be treated and the culture clear
- Blood thinners are managed according to the surgeon's instructions
- Consent is taken, an IV line started and prophylactic antibiotics given
- 4
The procedure
30–90 minutes- Spinal or general anaesthesia is given
- For RIRS and URSL the scope passes through the natural urinary passage — no incision
- For mini-PCNL a small tract is made through the flank under imaging guidance
- A holmium laser fragments or dusts the stone, and fragments are retrieved
- A DJ stent is placed where needed to keep the kidney draining
- Fragments are collected and sent for compositional analysis
- 5
Recovery and observation
4 hours to 2 days- Vitals, urine output and urine colour are monitored
- Blood-stained urine for a day or two is expected, not alarming
- High fluid intake is started as soon as you are able to drink
- Most ESWL, RIRS and URSL patients go home the same day or the next morning
- 6
Stent removal and prevention plan
1–2 weeks, then ongoing- The DJ stent is removed in a brief office cystoscopy after one to two weeks
- A check ultrasound or X-ray confirms the kidney is clear
- The stone analysis result guides a personalised diet and fluid plan
- A metabolic workup is arranged if this is a recurrent stone
- Your coordinator schedules the follow-up scans that catch a new stone early
How to prepare
- Complete the CT KUB, urine culture and blood tests before the date is fixed
- Any urinary infection must be fully treated first — this is not negotiable
- Tell your surgeon about blood thinners, diabetes medication and any heart condition
- Fast for 6–8 hours before the procedure as instructed
- Bring all previous scans and any earlier stone analysis reports
- Arrange for an adult attendant to accompany you
- If you have passed a stone at home, bring it — the analysis genuinely changes your prevention plan
Why patients choose this procedure
No external cut in most cases
RIRS and URSL reach the stone through the body's own urinary passage. Even PCNL uses a tract of only a few millimetres rather than the large flank incision that open stone surgery once required.
Very high stone-free rates
Above 95% for ureteric stones treated with URSL, and 90–95% for kidney stones up to 20 mm treated with RIRS — usually in a single session.
Effective regardless of stone hardness
The holmium laser fragments even dense stones that shockwave lithotripsy cannot break, which removes the main cause of repeated failed ESWL sessions.
Short stay and quick return to work
Most patients go home the same day or the next morning, and are back at desk work within two to four days.
Protects kidney function
Relieving obstruction promptly prevents the permanent loss of function that follows a kidney left blocked for weeks — damage that can occur silently, without pain.
A prevention plan, not just a procedure
Stone analysis and a metabolic workup convert a one-off treatment into a strategy that addresses a recurrence rate that would otherwise sit near 50% within a decade.
Possible risks and side effects
Blood in the urine
Expected for one to three days after any stone procedure, and for longer after PCNL. Increasing amounts of blood, or clots preventing you from passing urine, should be reported.
Urinary infection and sepsis
The most serious risk, and the reason infection must be treated before rather than during a procedure. Fever, chills or rigors afterwards require immediate assessment.
Stent-related symptoms
A DJ stent commonly causes urinary urgency, frequency, flank discomfort while passing urine and some blood. Unpleasant but temporary, and it resolves completely on removal. Never delay removal beyond the date given — a forgotten stent can encrust and become a serious problem.
Residual fragments and steinstrasse
Fragments can remain and grow, or line up in the ureter after ESWL to form a column that obstructs it. This is why a check scan after treatment matters rather than assuming clearance.
Ureteric injury or stricture
Uncommon. Difficult instrumentation can rarely injure the ureter, and healing may leave a narrowing that needs later treatment. Gentle technique and a pre-placed stent reduce this risk.
Bleeding after PCNL
Because a tract is made through kidney tissue, significant bleeding is a recognised though uncommon complication, occasionally needing transfusion or embolisation. Mini-PCNL's smaller tract reduces it.
Recurrence
Around half of stone formers develop another stone within five to ten years without prevention. With stone analysis, a metabolic workup and a fluid and diet plan actually followed, that risk falls substantially.
What recovery looks like
Recovery after endoscopic stone surgery is quick, and the dominant instruction is simple: drink. Urine output is what flushes residual dust and small fragments out of the system.
First 24 hours: expect blood-stained urine and some burning while passing it. Both are normal. Drink 3 to 4 litres through the day. If a DJ stent is in place, some urgency and a pulling sensation in the flank as you pass urine are expected rather than a complication.
Days 2 to 4: the burning settles and the urine clears progressively. Most patients with desk jobs return to work in this window. Continue high fluid intake and take the prescribed antibiotics to completion.
Week 1 to 2: the DJ stent is removed in a brief office cystoscopy that takes a few minutes and needs no anaesthesia beyond a local gel. Most patients notice immediate relief of the urgency the stent was causing. A check ultrasound or X-ray confirms the kidney is clear.
Beyond two weeks: normal activity, including gym and travel, resumes. This is when prevention begins in earnest — the stone analysis result comes back, and your fluid target, salt limit and dietary plan are set to your specific stone type rather than to generic advice.
Contact your care coordinator immediately if you develop fever or chills, are unable to pass urine, see heavy blood or clots, or have severe flank pain that painkillers are not controlling.
What to eat and what to avoid
Recommended
- 3 to 4 litres of water daily — enough that your urine stays pale straw-coloured
- Extra fluid in summer and on days involving heavy physical work or sweating
- Citrus fruit — lemon, sweet lime, orange — since citrate is the body's natural stone inhibitor
- Normal dietary calcium from milk, curd and paneer, taken with meals
- Fresh vegetables and fruit for potassium and fibre
- Barley water and coconut water
- A glass of water before bed and again if you wake at night, since urine is most concentrated overnight
Best avoided
- Excess salt, papad, pickles and packaged snacks — high sodium drives calcium into the urine
- Large quantities of oxalate-rich food: spinach, beetroot, nuts, chocolate and strong tea
- Excessive animal protein, red meat and organ meat, especially for uric acid stones
- Aerated drinks, particularly colas containing phosphoric acid
- High-dose vitamin C supplements, which the body converts to oxalate
- Calcium supplements taken between meals rather than with food
- Deliberately cutting out dietary calcium — a common and counterproductive mistake that actually increases oxalate absorption and raises stone risk
- Holding urine for long periods
Post-operative care, at no extra cost
- Diet and lifestyle consultation with a nutritionist
- Scheduled follow-up calls until you are fully recovered
- Free cab for the follow-up visit
- 24×7 access to your care coordinator for any concern
Kidney Stones treatment cost
₹45,000 – ₹1,50,000
The range depends heavily on which procedure is needed — shockwave lithotripsy sits at the lower end, RIRS and mini-PCNL higher — as well as stone size and number, whether a DJ stent is placed, whether a laser and disposable scope are used, your city, the hospital and your room category. Kidney stone surgery is covered by virtually all health insurance policies. Our insurance desk checks your eligibility and files the cashless request before admission, at no charge.
Inside the care journey
Kidney Stones — your questions answered
It depends almost entirely on size and position. Stones under 5 mm pass spontaneously in about 80% of cases; between 5 and 10 mm roughly half do; above 10 mm spontaneous passage is unlikely. Your CT gives the exact measurement, so this is a question with a fairly precise answer rather than a guess. If waiting is reasonable, you will be given painkillers, an alpha-blocker and a strainer to catch the stone.