Guide to Do You Need A Surgery For Removal Of Stone
Learn whether surgery is required for kidney stone removal, the types of procedures available, and when lifestyle changes or medications may be enough.
Written by Dr. Siri Nallapu
Reviewed by Dr. Dhankecha Mayank Dineshbhai MBBS
Last updated on 8th Sep, 2025
That sudden, crippling pain in your side or back, often described as one of the worst pains imaginable can be a terrifying sign of a kidney stone. As the stone moves through your urinary tract, it can cause a world of discomfort and raise a pressing question: will this pass on its own, or do I need surgery for removal of the stone? The answer isn't always straightforward. This guide cuts through the confusion to provide a clear, comprehensive look at stone treatment. We'll explore the different types of stones, when watchful waiting is appropriate, and crucially, when surgical intervention becomes necessary. You'll learn about the various surgery options, from non-invasive techniques to minimally invasive procedures, empowering you to have an informed conversation with your doctor about the best path forward for removal and long-term health.
Understanding Stones: It's Not Just Kidneys
While "kidney stone" is the common term, stones can form and get stuck in different parts of the biliary and urinary systems, each requiring a slightly different approach.
Kidney Stones (Nephrolithiasis)
These are hard deposits of minerals and salts that form inside your kidneys. They can be as small as a grain of sand or as large as a golf ball. Most are composed of calcium oxalate, but they can also be made of uric acid, struvite, or cystine. They often don't cause symptoms until they begin to move into the ureter.
Ureteral Stones
This isn't a different type of stone, but rather a kidney stone that has moved out of the kidney and into the ureter, the narrow tube connecting the kidney to the bladder. This is where they most commonly cause obstruction and the severe pain known as renal colic.
Gallstones (Cholelithiasis)
These stones form in the gallbladder, a small organ that stores bile. They are typically made of cholesterol or bilirubin. While many people have "silent" gallstones, they can cause intense pain (biliary colic), inflammation (cholecystitis), and blockages if they lodge in a duct. The surgical removal approach for gallstones is different from that of kidney stones.
Consult a Top Nephrologist
When is Surgery Necessary? Key Indicators
Not every stone requires surgery. Doctors consider several factors before recommending an invasive procedure.
Size and Location Matter
The general rule of thumb is that smaller stones (less than 5mm) have a good chance of passing naturally. Stones between 5mm and 10mm may pass but are less likely, and stones larger than 10mm often require intervention. Location is also critical; a 6mm stone at the very end of the ureter is more likely to pass than a 6mm stone stuck at the top near the kidney.
Persistent Symptoms and Pain
If a stone is causing unmanageable pain that doesn't respond to medication, surgery becomes a viable option to provide relief. Similarly, if a stone fails to pass after a reasonable period (e.g., 4-6 weeks) despite conservative management, intervention may be needed.
Risk of Complications
This is the most critical indicator. Surgery is often necessary if the stone is causing:
Obstruction: Blocking the flow of urine, which can lead to kidney damage.
Infection: A blocked stone can cause a urinary tract infection that can spread to the kidney (pyelonephritis) and become life-threatening if it enters the bloodstream (sepsis). This is a medical emergency.
Recurrent UTIs or Bleeding: Continuous problems caused by the stone's presence.
Risk to Kidney Function: If the stone is in a solitary kidney or is causing progressive kidney function decline.
If you're experiencing severe symptoms that suggest a complication, it's crucial to consult a specialist immediately. You can consult a urologist online with Apollo24|7 for a preliminary evaluation and to determine if you need further tests.
Non-Surgical Stone Treatment Options to Try First
Before jumping to surgery, doctors almost always exhaust less invasive options first.
Watchful Waiting
For small, asymptomatic stones, the best course of action might be to drink plenty of water (2-3 quarts per day) and wait for the stone to pass naturally. Pain management with NSAIDs is often prescribed during this time.
Medical Expulsive Therapy (MET)
For stones in the ureter that are likely to pass, doctors may prescribe alpha-blocker medications (like tamsulosin). These drugs relax the muscles in the ureter, making it easier for the stone to pass and reducing pain.
Extracorporeal Shock Wave Lithotripsy (ESWL)
This is a common non-invasive procedure that uses high-energy sound waves to break the stone into tiny fragments that can then be passed more easily in your urine. You are placed in a water bath or on a soft cushion, and the shock waves are targeted at the stone using X-ray or ultrasound guidance. It is typically used for stones less than 2cm in size located in the kidney or upper ureter.
Types of Surgery for Stone Removal
When non-surgical methods fail or are unsuitable, these are the primary surgical techniques used.
Ureteroscopy (URS)
This is the most common procedure for stones lodged in the ureter or kidney. It is a minimally invasive removal technique.
How Ureteroscopy is Performed
A thin, flexible scope (a ureteroscope) is passed through the urethra and bladder and up into the ureter. Once the surgeon sees the stone, small instruments can be used to basket it out whole. For larger stones, a laser fiber is used to break the stone into dust (laser lithotripsy), which is then flushed out.
Recovery After URS
This is typically an outpatient procedure. You might go home the same day with a temporary stent placed in the ureter to help it heal and drain. The stent is usually removed after a week or two. Most people can return to normal activities within a few days.
Percutaneous Nephrolithotomy (PCNL)
This is the preferred surgery for very large kidney stones (typically >2cm) or stones that have failed ESWL.
How PCNL is Performed
The surgeon makes a small incision (about 1cm) in your back and creates a direct tunnel into the kidney. A nephroscope is passed through this tunnel to locate and remove the stone using ultrasonic or laser energy. This procedure is highly effective for large stone burdens.
Recovery After PCNL
This requires a short hospital stay (1-2 days). You will have a nephrostomy tube draining urine from the kidney for a brief period after surgery. Full recovery takes 2-3 weeks.
Laparoscopic or Open Surgery
These traditional methods are very rare today, reserved for extremely complex cases where anatomy is abnormal or other techniques have failed. They involve larger incisions and longer recovery times.
Surgical Removal of Gallstones
The approach for gallstones is fundamentally different. There is no equivalent to ESWL or URS for the gallbladder.
Laparoscopic Cholecystectomy
This is the gold standard surgery for removal of the gallbladder (and the stones within it). It is a minimally invasive procedure where the surgeon makes several small incisions in the abdomen. A laparoscope (a small camera) and surgical instruments are inserted. The gallbladder is then carefully separated and removed. Since the gallbladder is not an essential organ, most people live a normal life without it. Bile simply flows directly from the liver into the small intestine.
Risks and Benefits of Stone Surgery
Like any procedure, stone surgery comes with a balance of risks and benefits.
Common Risks and How to Mitigate Them
Infection: Treated with antibiotics.
Bleeding: Usually minor.
Pain: Managed with post-operative medication.
Stone Fragments: Pieces may remain, requiring a second procedure.
Injury to surrounding organs: A rare but serious risk.
Choosing an experienced surgeon at a reputable hospital significantly mitigates these risks.
The Benefits of Surgical Intervention
The primary benefit is the removal of the source of pain, infection, and potential kidney damage. It provides a definitive solution, often with a quick recovery thanks to modern minimally invasive techniques. It restores normal urinary or digestive function and prevents future emergencies.
Life After Stone Surgery: Recovery and Prevention
You may have a stent or a catheter temporarily. It's crucial to stay hydrated, manage pain with prescribed medication, and avoid strenuous activity for the period recommended by your surgeon. Follow-up appointments are essential to ensure complete removal of the stone and proper healing.
Diet and Hydration for Prevention
The best way to avoid future surgery is to prevent new stones from forming.
Hydration: Drink enough water to produce at least 2.5 liters of urine a day.
Dietary Changes: Depending on your stone type:
Calcium Oxalate: Reduce sodium and oxalate-rich foods (spinach, nuts, chocolate). Do not reduce calcium intake without medical advice.
Uric Acid: Reduce red meat, organ meats, and alcohol.
Sometimes, your doctor may recommend Apollo24|7's home collection services* for 24-hour urine tests to analyze your stone risk profile and tailor a specific prevention plan.
Conclusion
Deciding whether you need surgery for removal of a stone is a significant decision that depends on a careful evaluation of the stone's characteristics and your symptoms. While the thought of surgery can be daunting, modern medical techniques have made these procedures safer, less painful, and more effective than ever before. The goal is always to preserve your organ function and relieve your pain with the least invasive method possible. By understanding your options, from watchful waiting to advanced surgical removal, you can actively participate in your treatment plan. Remember, the best outcome starts with a accurate diagnosis. If you are experiencing symptoms of stones, consult a doctor online with Apollo24|7 to get the right advice and imaging tests to determine the best course of action for your health.
Consult a Top Nephrologist
Consult a Top Nephrologist
Dr Ch Sashidhar
Nephrologist
20 Years • MBBS, MD General Medicine, DNB, Nephrology
Secunderabad
Apollo Hospitals Secunderabad, Secunderabad
Dr Praveen Kumar Etta
Nephrologist
10 Years • MBBS,MD DM(SGPGI) FORMER ASST(PIMS)
Hyderabad
Apollo Spectra Ameerpet, Hyderabad
Dr. Pardha Saradhi
Nephrologist
9 Years • MBBS, MD-DNB (Gen. Med.), DNB (Nephro)
Hyderabad
Apollo Hospitals D R D O kanchanbagh, Hyderabad
(75+ Patients)
Dr. Jignesh Pandya
Nephrologist
27 Years • MD(Medicine), DNB(Nephrology).
Bilaspur
Apollo Hospitals Seepat Road, Bilaspur
(25+ Patients)
Dr. Aswini Kumar Panigrahi
Nephrologist
23 Years • MBBS, MD (Int. Med.), DNB Nephro
Hyderabad
Apollo Hospitals Jubilee Hills, Hyderabad
(200+ Patients)
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Frequently Asked Questions
1. How painful is kidney stone surgery?
Modern stone surgery is performed under anesthesia, so you feel no pain during the procedure. Post-operative pain is common but is effectively managed with medication. The pain from the surgery is typically much less severe than the pain of an obstructing stone.
2. What is the success rate of laser stone surgery?
Ureteroscopy with laser lithotripsy has a very high success rate, often exceeding 95% for stones in the ureter and 85-90% for stones within the kidney itself. The rate depends on the stone's size, location, and composition.
3. How long does it take to recover from a ureteroscopy?
Most people can return to light activities within 24-48 hours. Full recovery, including returning to heavy lifting and strenuous exercise, usually takes about 1-2 weeks, especially after the temporary stent is removed.
4. Can stones come back after surgery?
Yes, unfortunately, having one stone significantly increases your risk of forming another. This is why preventive measures like high fluid intake and dietary changes are critically important after your surgery.
5. Is there an alternative to gallbladder removal for gallstones?
In very rare and specific cases, medication can be used to dissolve small cholesterol stones, but this takes months or years and has a high recurrence rate. For symptomatic stones, laparoscopic cholecystectomy is the standard and most effective treatment to prevent future complications.