Kidney ยท Stone pathway
Kidney stones: treatment pathway and what to do first
Most kidney stones form when the natural balance of minerals and water in the urine shifts and salts crystallize into stones. Dr. Mally treats stone disease alongside urologic cancer, which shapes his approach: start with the decision that matters most, whether this is an emergency, then work through diagnosis, removal choices and prevention.
Common signs
- Waves of flank pain
- Blood in the urine
- Nausea, vomiting, urinary urgency
Go to urgent care if
- Fever or chills with pain
- You cannot urinate
- Pain you cannot control
Options in brief
- Observation with pain control
- Lithotripsy or ureteroscopy
- PCNL for very large stones
Recognize a stone episode
Pain in the side and back below the ribs that may travel to the groin and comes in waves; pain or spasm with urination; pink, red or brown urine; cloudy or foul-smelling urine; nausea and vomiting; a constant need to urinate in small amounts; fever and chills if infected. Some stones cause little or no pain, depending on size, shape and position.
Blood in the urine is not automatically a stone. It can have other causes, and in adults it deserves evaluation of the whole urinary tract. That is why a urologist who also treats kidney and bladder cancer looks at it carefully.
Locate the stone and find out why it formed
History, exam, urine tests and usually imaging establish stone size, position and whether urine is blocked. Those facts decide whether observation is safe. Common contributors include too little fluid, a diet high in protein or sodium, low urine citrate, metabolic conditions (obesity, diabetes, gout), hyperparathyroidism and bowel disease or surgery. If you pass a stone, save it for lab analysis.
Match the treatment to the stone
| Option | How it works | What to expect and trade-offs |
|---|---|---|
| Observation | Small stones may pass with pain control and monitoring. | Only safe if pain is controlled, there is no fever and urine is flowing. A stone can stall or block. |
| Shock wave lithotripsy (ESWL) | Shock waves from outside the body break the stone into fragments that pass. | Anesthesia is usually used, and most people go home the same day. Tell the team about blood thinners and other medicines; changes must follow your doctors’ plan. Mild side pain and blood in the urine are common for a few days; drink plenty of fluids. Fragments can still cause pain as they pass, and a stone sometimes needs repeat treatment. |
| Ureteroscopy with laser lithotripsy | A thin scope goes through the urethra to the stone, which is broken with a laser and removed. | General anesthesia, no cuts, usually home the same day. A temporary stent helps the kidney drain and is removed in about a week; it can cause discomfort and urgency, so ask what to expect. A stone sometimes needs further treatment. |
| Percutaneous nephrolithotomy (PCNL) | A scope enters the kidney through the back for very large stones (over about 2.5 cm) or stones filling the kidney. | Hospital procedure with a stay of at least a night. |
Ask which approach Dr. Mally recommends for your stone and where it would be done.
Prevent the next one
People who have had one stone often form another, so the cause matters. Analysis of the stone, and sometimes a 24-hour urine collection, comes first. For most people, enough fluid to keep urine dilute is central: six to eight 8-ounce glasses a day is a common target, more in heat or with heavy sweating, unless a doctor has limited your fluids. Citrus drinks may help because citrate discourages crystals. Medicines such as potassium citrate, or antibiotics for infection-related stones, are chosen by stone type. Diet changes should follow the stone type, not a generic list.
Questions & answers
What are the symptoms of a kidney stone?
Flank, back or lower-belly pain in waves, blood in the urine, painful or frequent urination, nausea and vomiting, sometimes fever. Fever or inability to urinate makes it urgent.
How are kidney stones removed?
Depending on size, location and type: observation, shock wave lithotripsy, ureteroscopy with laser lithotripsy or, for very large stones, percutaneous nephrolithotomy. Your urologist recommends based on your imaging and health.
Can untreated stones cause complications?
Yes. A stone that blocks the urinary tract can cause infection, kidney damage and, in severe cases, kidney failure.
Should blood in my urine always be assumed to be a stone?
No. It deserves evaluation to look for other causes, including infection and tumors of the urinary tract.
Advanced Urology resources
- Kidney stone care at Advanced Urology: Advanced Urology’s overview of this condition and its care team.
- Shock wave lithotripsy at Advanced Urology
- Signs of kidney stones: common questions
This page is general information and may not apply to your situation. Talk with your doctor about what is right for you.
Next steps
Kidney stone care at Advanced Urology or call (404) 586-4570 (Advanced Urology line)