Kidney Stone Treatment Options: How to Choose the Right Procedure

CONDITIONS

Written and Medically Reviewed by Mr Ivo Dukic, Consultant Urologist | Last updated: 10/04/2026

A guide to ESWL, ureteroscopy, PCNL and conservative management — from a high-volume Birmingham kidney stone specialist

Already know which treatment you need? Go straight to

- [Private ureteroscopy in Birmingham →]— for ureteric and kidney stones up to approximately 2 cm

- [Private PCNL surgery in Birmingham →]— for large, complex or staghorn stones

- [Mini PCNL in Birmingham →]— for stones typically 1.5–3.5 cm requiring keyhole access

- [Private kidney stone surgery — costs, waiting times and booking →]

Not sure which treatment you need? Read on — this guide will help you understand your options.

Secretary: 0121 716 9046 — Monday to Friday, 8am–6pm · Appointments within 7 days

You've Been Diagnosed With a Kidney Stone — What Happens Next?

Kidney stones are diagnosed most commonly via a CT KUB scan — a low-radiation CT scan that shows the size, location, number and density of stones in the kidney and ureter. Once a stone is found, the management decision is made based on a combination of factors:

Stone factors:

- Size — the single most important predictor of whether a stone will pass on its own or require surgery

- Location — ureteric stones behave differently from stones within the kidney; upper, mid and lower ureter have different passage rates

- Density (measured in Hounsfield Units on CT) — hard stones respond poorly to shockwave treatment; softer stones may be suitable for dissolution

- Composition — different stone types (calcium oxalate, uric acid, struvite, cystine) have different treatment implications

- Complexity — branching, multiple or multi-calyceal stones change the surgical approach

Kidney factors:

- Function of the affected kidney

- Anatomy — horseshoe kidney, pelvic kidney, previous surgery

- Whether the stone is causing obstruction or hydronephrosis

Patient factors:

- Symptoms — severity of pain, presence of infection, ability to pass urine

- Medical history — anticoagulation, single kidney, pregnancy, occupational factors

- Personal priorities — speed of recovery, risk tolerance, fertility considerations

This is why kidney stone management is always individualised. Two patients with a "9mm stone" can have very different treatment plans depending on where the stone is, what it is made of, and what the patient's other circumstances are. Mr Dukic will review all of these factors at your consultation and recommend the approach most likely to achieve stone clearance while minimising disruption to your life.

Can a Kidney Stone Pass Without Surgery?

The majority of kidney stones — particularly those under 4–5 mm — will pass spontaneously given time, adequate hydration, and appropriate pain management. However, spontaneous passage rates fall sharply as stone size increases, and stones causing significant symptoms, obstruction or infection require more urgent intervention.

Conservative management (watchful waiting) is appropriate when:

- The stone is small (generally under 5 mm) and the patient has tolerable symptoms

- There is no infection, no significant kidney obstruction, and kidney function is normal

- The patient can manage pain at home and is able to pass urine freely

- There are no occupational reasons requiring immediate resolution (e.g. pilots, heavy machinery operators, drivers)

Conservative management is NOT appropriate when:

- The stone is causing a fever — this is a urological emergency requiring urgent hospital assessment

- The stone is obstructing a single functioning kidney

- The patient has intractable pain despite adequate analgesia

- The stone has not moved or passed after 4–6 weeks of expectant management

Medical expulsive therapy: Alpha-blocker medication (tamsulosin) is sometimes prescribed alongside conservative management to relax the ureter and improve the likelihood of spontaneous passage for suitable ureteric stones. Evidence for its benefit is modest but it is a reasonable option for selected patients. This is an unlicensed medication in women.

If you are in severe pain: go to your nearest Emergency Department. Birmingham patients should attend Queen Elizabeth Hospital, Heartlands Hospital or City Hospital for urgent assessment. Kidney stone pain requires prompt assessment — do not attempt to manage a severe episode at home without medical review.

Comparing Kidney Stone Treatments — ESWL, Ureteroscopy and PCNL

We offer the following treatments for kidney or ureteric stones privately and through the NHS:

Extra-corporeal shockwave lithotripsy (ESWL)

No anaesthetic · Day case · Oral analgesia (NSAIDs) · No incision · Awake throughout

Best for: Single kidney stones up to approximately 1.5 cm in diameter, with favourable stone density (lower Hounsfield units) and accessible stone position. Well-suited to patients who want to avoid general anaesthetic and are prepared for possible repeat sessions (maximum usually two in the ureter and three in the kidney).

Stone-free rate: 70–80% for suitable stones after several sessions. Multiple sessions are sometimes required — each 45–60 minutes, typically 2 weeks or more apart.

Not suitable for: Hard stones (calcium oxalate monohydrate, cystine), very large stones, stones behind the ribs or in the lower pole of the kidney (fragmented stones may not drain), patients on anticoagulation, patients with pacemakers.

A ureteric stent is not required.

Recovery: Most patients go home within 2 hours. Blood in the urine and mild flank discomfort are expected for a few days. Return to normal activities within 1–2 days for most.

Mr Dukic performs ESWL at the University Hospitals Birmingham NHS Foundataion Trust. For private ESWL, please discuss availability at your consultation.

An animated video (below) from the European Association of Urology explains the procedure further. You can also find more information about shockwaves in treatment at the British Association of Urological Surgeons.

Ureteroscopy and LASER lithotripsy

General anaesthetic · Day case (most patients) · No incision · Stent usually placed for 5–7 days

Best for: Ureteric stones of any size; kidney stones up to approximately 1.5 - 2 cm in diameter. Often, the first-line treatment for most patients requiring surgery for a ureteric stone. Stentless option available for suitable, uncomplicated cases.

Stone-free rate: 85–95% for ureteric stones under 1 cm. 70–90% for kidney stones, depending on size, location and stone composition. Single-procedure clearance in the majority of cases using Thulium fibre laser.

Not suitable for: Very large stones (above approximately 2 cm), where PCNL achieves better stone-free rates in a single procedure.

Stent required: Yes, in most cases — stent-on-string for 3–7 days, usually removed in clinic (by pulling the strings). Stentless ureteroscopy is offered for suitable patients.

Recovery: Home the same day for the majority of patients. Return to desk work within 1–3 days for most. Stent removal at 3–7 days ends the recovery period for the majority of patients.

→ [Full guide to private ureteroscopy in Birmingham →]

Percutaneous nephrolithotomy (PCNL)

General anaesthetic · 1 night in hospital (most cases) · Small back incision (pencil-sized with mini PCNL) · Stent usually 3–5 days

Best for: Kidney stones above approximately 1.5–2 cm; staghorn calculi; multiple stones; lower pole stones with poor drainage anatomy; stones resistant to ureteroscopy or ESWL.

Stone-free rate: Highest stone-free rates of all three modalities for large or complex stones — typically 80–95% for a single procedure, depending on stone volume and anatomy.

Not suitable for: Small stones where ureteroscopy or ESWL achieves equivalent results with a simpler recovery profile.

Stent required: Yes for the majority of patients — stent-on-string for 3–7 days with removal in clinic in most cases. Nephrostomy tube very rarely required with mini PCNL.

Recovery: 1 night in hospital. Return to light activity within 1–2 weeks. Return to full activity within 2–4 weeks.

→ [Full guide to private PCNL surgery in Birmingham →]

→ [Mini PCNL — smaller access, faster recovery →]

Below is an animated video from the European Association of Urology explains the procedure further or you can read more about the procedure in detail, including miniPCNL, super-miniPNCL and endoscopic combined intrarenal surgery on the percutaneous nephrolithotomy page.

Stone dissolution (uric acid stones only)

No surgery · Daily oral medication · Weeks to months for full dissolution

Best for: Confirmed or suspected uric acid stones (typically low-density on CT, under 500 Hounsfield Units and acidic urine). Accounts for approximately 10% of all kidney stones.

How it works: Alkalinising medications (potassium citrate, sodium bicarbonate) raise urine pH above 6.5, creating an environment in which uric acid stones gradually dissolve over weeks to months. Additional medications (allopurinol, febuxostat) may be used to reduce uric acid production.

Stone-free rate: Highly effective for true uric acid stones — dissolution rates of 80–90% reported in selected series. Requires patient compliance with daily medication and regular monitoring.

Not suitable for: Calcium oxalate stones (the most common type), which are not soluble and cannot be dissolved with medication. CT density measurement is used to identify likely uric acid stones before embarking on dissolution therapy.

→ [Full guide to dissolving kidney stones →]

Which Treatment Does My Stone Size Suggest?

The following is a clinical guide based on EAU (European Association of Urology) and BAUS guidance. Individual assessment always refines these thresholds — this is a starting point for understanding, not a substitute for a personal recommendation.

Under 5 mm:

Most will pass spontaneously with conservative management. Surgery is rarely required unless symptomatic obstruction, infection, or failure to progress after 4–6 weeks.

5–10 mm (ureteric stones):

Many will pass with time and medical expulsive therapy. Stones at the lower end of this range in the ureter have a 50–70% spontaneous passage rate. Surgery (usually ureteroscopy) is recommended if the stone fails to pass, causes significant pain, or is associated with obstruction or infection.

5–15 mm (kidney stones):

Symptomatic kidney stones in this range are typically treated with ESWL (if stone density and position are favourable) or ureteroscopy. ESWL may require more than one session for stones approaching 15 mm.

10–20 mm:

Ureteroscopy is generally preferred over ESWL for this size range — stone-free rates in a single procedure are higher. PCNL begins to become the preferred option for larger stones at the upper end of this range, particularly in the kidney.

Above 20 mm (2 cm):

PCNL is the recommended first-line surgical option. Stone-free rates are substantially higher than ureteroscopy for this stone volume. Mini PCNL achieves equivalent stone clearance to standard PCNL with a better recovery profile for most patients.

Staghorn and multi-calyceal stones:

PCNL — often with ECIRS (endoscopic combined intrarenal surgery) for complex distributions. These cases require specialist planning and are best managed at high-volume centres.

Lower pole kidney stones:

These present specific challenges regardless of size. Drainage from the lower pole after ESWL is often poor, making ureteroscopy or PCNL preferable even for moderate-sized stones. Mr Dukic will advise specifically based on your CT anatomy.

Already Diagnosed and Waiting for Surgery?

NHS kidney stone surgery waiting times in Birmingham and nationally have extended significantly in recent years. Non-emergency stone surgery — including ureteroscopy for a ureteric stone and PCNL for a large kidney stone — can involve waits of several months even when a stent has already been placed.

The clinical cost of waiting with a stent

A ureteric stent is a temporary measure. It relieves the obstruction from a stone but does not treat it. The longer a stent remains in situ, the higher the risk of encrustation, infection, and stent-related complications. The typical safe stent dwell time is 3–6 months — though many NHS patients wait longer than this before their definitive procedure.

If you are already waiting for kidney stone surgery and want to understand your private options — including costs, timelines and what is involved — the following page covers this in detail:

→ [Private kidney stone surgery in Birmingham — costs, waiting times and booking →]

Preventing Another Kidney Stone

Kidney stone disease is a chronic condition. Approximately 50% of patients who have had one stone will develop another within 5–10 years, and patients with multiple stones face a significantly higher recurrence risk.

Prevention begins with understanding why your stone formed. After your stone has been treated (or sent for analysis if retrieved), Mr Dukic will discuss metabolic assessment where appropriate — blood and urine tests that identify the underlying biochemical reason for stone formation.

The evidence-based foundations of prevention are:

Hydration: Aim for at least 2.5 litres of urine output per day. The goal is colourless or pale yellow urine at all times. This is the single most effective measure for all stone types.

Dietary modification: Tailored to your stone type. Calcium oxalate stones — the most common type — benefit from reduced sodium and animal protein, adequate dietary calcium, and limitation of very high-oxalate foods. Uric acid stones require dietary purine restriction and urine alkalinisation.

Metabolic assessment: For recurrent stone formers or those with multiple stones, blood and urine tests identify specific abnormalities (hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia) that can be targeted with specific medications.

Medication: Where dietary measures are insufficient, medications such as thiazide diuretics (for calcium stones), allopurinol (for uric acid stones), or potassium citrate (for multiple stone types) may be recommended.

→ [Full guide to kidney stone prevention →]

→ [Diet and kidney stone prevention →]

Frequently Asked Questions About Kidney Stone Treatment

What size kidney stone requires surgery?

As a general guide, kidney stones under 5 mm will usually pass spontaneously. Stones above 10 mm are unlikely to pass without surgery. Stones between 5 and 10 mm occupy a middle ground — many will pass with time and medication, but surgery is often recommended if there is no progression after 4–6 weeks, or if there is significant pain, obstruction or infection. The stone's location, density and shape also influence the decision, which is why a personal assessment is always more accurate than size alone.

What is the best treatment for a kidney stone?

There is no single "best" treatment — the right option depends on your stone size, location, density and composition, your kidney anatomy, and your personal priorities around recovery time. ESWL is appropriate for smaller, accessible, lower-density stones. Ureteroscopy is first-line for ureteric stones and kidney stones up to approximately 2 cm. PCNL achieves the highest stone-free rates for large or complex stones. Mr Dukic will recommend the approach most likely to clear your stone in a single procedure while minimising recovery time.

Can a kidney stone be treated without surgery?

Yes — small stones can pass spontaneously, and uric acid stones (approximately 10% of all stones) can be dissolved with oral medication. The majority of stones requiring treatment, however, cannot be dissolved and do need one of the three surgical approaches (ESWL, ureteroscopy, or PCNL). Mr Dukic will confirm your stone type from the CT density measurements and recommend accordingly.

How long is the wait for kidney stone surgery in Birmingham?

NHS waiting times for kidney stone surgery in Birmingham vary significantly depending on the urgency of the case and the specific Trust. Non-emergency stone surgery can involve waits of several months. Private patients with Mr Dukic are typically seen for consultation within 7 days and can have surgery listed within weeks. See our guide to [private kidney stone surgery in Birmingham →](/private-kidney-stone-surgery-birmingham) for current timelines and costs.

Can I choose my surgeon for kidney stone surgery?

Yes — both on the NHS and privately. On the NHS you have the right to choose a named consultant under the NHS Constitution. Privately, you book directly with Mr Dukic. For complex stone disease, surgeon experience and annual case volume are among the strongest predictors of stone-free rates and complication risk. Mr Dukic performs approximately 50–70 ureteroscopy and 50–60 PCNL procedures per year — among the highest volumes in the West Midlands.

Is ESWL available privately in Birmingham?

Mr Dukic performs ESWL at University Hospitals Birmingham NHS Foundation Trust. Private ESWL availability varies — please discuss this at your consultation. For most patients who choose private treatment, ureteroscopy is offered as an alternative to ESWL for suitable stone sizes, as it typically achieves stone-free status in a single procedure rather than requiring multiple sessions.

What happens if my stone is not cleared completely after surgery?

Incomplete stone clearance is more common with very large or complex stone burdens. Mr Dukic audits his stone-free rates by stone type and discusses realistic expected outcomes at your pre-operative consultation — not as a generic statistic, but specific to your stone. If residual fragments are found on the post-operative CT scan (taken at 2–3 months), options include further ureteroscopy, repeat PCNL or ESWL for residual stones, or watchful waiting for small, clinically insignificant fragments.

What is the difference between PCNL and mini PCNL?

Standard PCNL uses a thumb-width (24–30 French) access channel. Mini PCNL uses a pencil-width (14–20 French) channel, resulting in less blood loss, less post-operative pain and a shorter hospital stay — typically one night rather than two — while achieving equivalent stone clearance for most stones. Approximately 70–80% of Mr Dukic's PCNL procedures are performed as mini PCNL in the supine position.

Laparoscopic, robotic or open surgery for kidney stones - Laparoscopic surgery or robotic surgery involves multiple keyhole incisions in the abdomen. This is rarely offered as almost all kidney stones can be treated with either shockwaves, ureteroscopy and LASER lithotripsy or percutaneous nephrolithotomy (PCNL) procedures. An open operation involves a large incision (10-15 cm) over the flank, to expose over the site of the kidney or ureter. Examples of where this treatment may be offered, include if other stone treatment methods have not been successful or if there is little or no remaining kidney function in a kidney with stone disease and the kidney should be removed. If this is the case we would refer you to a urologist specialising in kidney removal.

Metabolic stone service – we work alongside our colleagues in the renal (kidney), biochemistry and microbiology departments to identify reasons why patients form recurrent kidney stones. Metabolic tests aim to prevent stone recurrence by identifying the underlying cause of kidney stone disease. Not all patients will require this service and the aim is to identify high-risk stone formers who would most benefit from further tests.

A National Reputation for Excellence in Stone Surgery

Mr Ivo Dukic is a leading Consultant Urological Surgeon whose Birmingham-based practice is an outstanding centre for kidney stone removal, making him a primary choice for patients across the UK. When searching for the best kidney stone surgeon the UK has to offer, patients rightly look for unparalleled expertise, a high volume of successful procedures, and a commitment to the latest treatments.

As one of the highest-volume stone surgeons in the country, Mr Dukic has dedicated his practice to the surgical management of kidney stones. This specialist focus ensures that every patient benefits from a depth of experience that is essential for achieving the best possible outcomes. His reputation as a leading kidney stone surgeon in the UK is built on his expertise in complex cases and his mastery of advanced, minimally invasive techniques. He is a renowned specialist in Percutaneous Nephrolithotomy (PCNL), including the ultra-modern mini-PCNL and ultra-mini PCNL procedures, which offer patients faster recovery times and reduced discomfort.

For patients throughout the UK seeking a definitive solution from an expert kidney stone surgeon, Mr Dukic's practice represents a national centre of excellence.

You can schedule an appointment with him for expert, bespoke advice through his Top Doctors profile or book an appointment through The Harborne Hospital, HCA Healthcare, The Priory Hospital, Edgbaston, Circle Health, Droitwich Spa, Circle Health or The Spire Parkway Hospital, Solihull.