When Do Kidney Stones Require Surgical Removal?

Posted on March 04, 2025 by root

Kidney stones are a common urological issue that can cause significant discomfort and disrupt daily life. While many kidney stones pass on their own with minimal intervention, others may require medical or surgical treatment. Understanding when surgical removal is necessary and knowing your treatment options can help you make informed decisions about your health.

At Justin Houman, MD Men’s Health in Los Angeles, CA, we offer comprehensive treatment options tailored to your needs, whether you’re dealing with a small, passable stone or a larger, more complex one that requires surgical intervention.

Non-Surgical Treatment Options for Kidney Stones

For many patients, small kidney stones (typically less than 5mm) can pass naturally without the need for surgery. In these cases, non-invasive treatments focus on easing discomfort and helping the stone move through the urinary tract. Non-surgical treatments include:

Alpha-blockers (Flomax): These medications help relax the muscles in the ureter, making it easier for the stone to pass naturally. Flomax is commonly prescribed for small stones to facilitate quicker and less painful passage.
Pain Management: Passing kidney stones can be painful. Over-the-counter pain relievers like ibuprofen or prescription medications can help manage discomfort during the process.
Hydration Therapy: Staying hydrated is key. Drinking plenty of water helps flush out small stones and reduces the risk of new stones forming.

Minimally Invasive & Surgical Treatment Options

Non-surgical treatments are often effective for small stones, but when stones become too large, get stuck, or cause complications, more advanced interventions may be needed. These include minimally invasive laser procedures as well as surgical intervention.

Shockwave Lithotripsy (ESWL) – Non-Surgical Kidney Stone Removal

Shockwave Lithotripsy (ESWL) is a non-invasive procedure that uses high-energy sound waves to break kidney stones into tiny fragments, allowing them to pass naturally through the urinary tract.

Best suited for stones up to 2 cm in size.
Performed as an outpatient procedure with no incisions.
Patients may experience minor discomfort as stone fragments pass but typically recover quickly.
ESWL is ideal for patients seeking a non-surgical option with minimal downtime.

Ureteroscopy & Laser Lithotripsy (Holmium Laser)

For medium-sized stones lodged in the ureter or kidney, ureteroscopy with laser lithotripsy is often the preferred method.

A thin, flexible scope is inserted through the urethra and bladder to reach the stone.
A Holmium laser is used to break the stone into smaller pieces.
This minimally invasive procedure requires no incisions and allows for quicker recovery.
Ureteroscopy is especially effective for stones that ESWL can’t reach or fully break down.

Percutaneous Nephrolithotomy (PCNL) – Surgery for Large Stones

For larger stones (over 2 cm) or complex cases, Percutaneous Nephrolithotomy (PCNL) is the most effective treatment.

A small incision is made in the back to access the kidney directly.
Special instruments are used to break and remove the stones.
PCNL is typically recommended for large, stubborn stones or staghorn calculi (stones that fill the kidney’s collecting system).

Though more invasive than other treatments, PCNL offers the highest success rate for complex and large kidney stones.

When Does a Kidney Stone Require Surgery?

Surgical removal is generally recommended when:

A kidney stone is too large to pass naturally (over 5-6 mm).
The stone causes severe pain or infection or blocks urine flow.
Non-surgical treatments have failed to remove the stone.
Recurrent urinary tract infections (UTIs) or kidney damage is present due to the stone.
Stones are located in areas difficult to reach with non-invasive methods.

Expert Kidney Stone Treatment in Los Angeles, CA

At Justin Houman, MD Men’s Health, we offer personalized treatment plans for kidney stones, ranging from non-invasive therapies to advanced surgical options. Dr. Houman is a board-certified urologist specializing in minimally invasive techniques to ensure you receive the most effective and comfortable care possible.

If you’re experiencing symptoms of kidney stones or want to discuss your treatment options, contact our Los Angeles office today to schedule a consultation. We’re here to help you find relief and get back to living your life, stone-free.

Posted on behalf of Justin Houman MD