Surgery Recovery Kidney Stone Surgery: Everything You Need to Know By Laura Newman Laura Newman Laura Newman is an award-winning journalist with expertise in clinical medicine, health policy, urology, oncology, neurology, and targeted therapies. Learn about our editorial process Updated on July 25, 2021 Medically reviewed by Kashif J. Piracha, MD Medically reviewed by Kashif J. Piracha, MD LinkedIn Kashif J. Piracha, MD, is board-certified in internal medicine and nephrology. He has an active clinical practice at Methodist Willowbrook Hospital in Houston, Texas. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents What Is Kidney Stone Surgery? Purpose How to Prepare What to Expect Recovery Kidney stone surgery involves the surgical removal of kidney stones that are too large to pass on their own, or are causing too much pain or an infection. Stones that are impairing kidney function may also require surgical removal. choicegraphx / Getty Images If a stone blocks the passage of urine from the kidney to the bladder, symptoms occur. These include severe pain in your lower abdomen or sides (between your ribs and hips). Blood in the urine may also occur. Surgical removal of the stone relieves symptoms and/or restores the normal flow of urine. What Exactly Are Kidney Stones? Kidney stones are pebble-like masses that become stuck in the kidney or ureter. They develop when substances like calcium, oxalate, cystine, or uric acid accumulate or become concentrated in the urine. These substances form tiny crystals and, eventually, these solid stones. What Is Kidney Stone Surgery? Kidney stone surgery involves a surgeon either physically removing a kidney stone whole or in pieces, or essentially blasting it apart so that it can be passed by the body. This surgery may be scheduled or performed urgently by a urologist—a healthcare provider who deals with diseases of the urinary tract. There are different types of kidney stone surgeries. Depending on the one performed, you may go home the same day or stay in the hospital for one or more nights. Surgery Types The type of surgery performed depends on factors like the size and location of the stone and patient preference. Depending on the surgery chosen, you may be discharged home on the same day or stay overnight in a hospital. Shock Wave Lithotripsy Shock wave lithotripsy (SWL) is the least invasive method for stone removal and is considered the first-line therapy for most kidney stones and many ureteral stones. This surgery entails using high-energy shock waves to break apart a kidney stone into tiny, fine fragments. Doing so allows the pieces to easily travel through the urinary tract and out of the body. Patients can often go home the same day as the procedure. They may stay one night in the hospital if the surgery was long or complicated. Ureteroscopy A ureteroscopy (URS) is used to treat stones in the ureter, especially stones closest to the bladder. A small, flexible tube called a ureteroscope is passed through the urethra and bladder and up the ureter to the location of the stone. The stone is removed whole or, if it's too large, broken up with a laser first. As with SWL, patients may go home the same day as their surgery or stay overnight in the hospital. Percutaneous Nephrolithotomy Percutaneous nephrolithotomy (PNL) is generally used for patients who have large stones (greater than 20 millimeters, mm) or staghorn stones (large, branching stones associated with urinary tract infections). During this surgery, an endoscope is inserted through a small incision in the back to visualize and remove the kidney stone. A laser may be used to break the stone into pieces prior to removal. In some cases, a nephrostomy tube may be temporarily inserted through the skin into your kidney to help drain urine. Patients undergoing percutaneous nephrolithotomy stay in the hospital for one to two nights. Laparoscopic and Robot-Assisted Surgery Laparoscopic and robot-assisted surgery is more invasive than the surgeries described thus far. It is usually utilized when one of them fails. The healthcare provider uses thin surgical instruments to remove the stone through small cuts made in the patient's abdomen. If a robot is used, the practitioner controls robotic hands that have surgical instruments attached to them instead. This surgery involves around a three-night stay in the hospital. Open Surgery Open surgery is rarely performed. It may be used in patients for whom minimally invasive approaches have failed and/or for those with staghorn stones, complex kidney or ureter anatomy, or morbid obesity. During open surgery, the stone is removed through a cut made in the patient's abdomen or side. A nephrostomy tube is placed temporarily to drain urine. Open surgery generally requires a six- to a nine-night hospital stay. Contraindications Some people may be advised against having surgery in general—for example, if they have bad reactions to anesthesia. Beyond that, though, there is almost nothing that would outright prevent you from having a kidney stone removal procedure. The exceptions relate to shock wave lithotripsy. If any of the following apply to you, you should not have SWL: Obesity Pregnancy Bleeding disorder Severe skeletal abnormalities Your healthcare provider may cautiously consider SWL if you have: Chronic kidney infection Scar tissue in the ureter Stones made up of cystine or certain types of calcium A stone that must be cleared immediately and/or completely A cardiac pacemakers Potential Risks There are specific risks associated with each type of kidney stone surgery. As an example, risks associated with shock wave lithotripsy include: Bleeding around the kidneyUrinary tract infectionBlockage of the urinary tract by stone fragments The most frequent risks associated with a ureteroscopy include: Ureteral stent discomfortUreteral wall injuryStone migration The main risks associated with percutaneous nephrolithotomy include: BleedingRenal pelvis perforation (when a hole forms inside the kidney)Hydrothorax (when fluid accumulates in the space surrounding the lung) Purpose of Kidney Stone Surgery The purpose of kidney stone surgery is to remove a stone in order to reduce symptoms and/or reverse a medical condition associated with the presence of the stone (e.g., urinary tract infection or acute kidney failure). Specific indications for kidney stone surgery include: Ureteral stones greater than 10 mmUncomplicated distal ureteral stones less than 10 mm that have not passed after four to six weeks of observationSymptomatic kidney stones without any other explanation for the patient's painUreteral or kidney stones in pregnant women that have not passed after an observation periodPersistent kidney obstruction related to stonesRecurrent urinary tract infections linked to stones Aside from the above indications, emergency surgery to remove a kidney stone may be warranted in the following cases: If the flow of urine from both kidneys is blocked and there is acute kidney injuryIf a patient has acute kidney injury from an obstructing stone and only one functioning kidneyIf a patient has an obstructing stone and a urinary tract infection Pre-Op Testing When kidney stone surgery is scheduled, various tests will be performed. Lab tests include: Complete blood count (CBC) Urinalysis Urine culture (to check for infection) If an infection is detected, it will be treated with antibiotics. A computed tomography (CT) scan of the abdomen and pelvis will also be obtained, if not already done. On the scan, if a patient has evidence of certain kidney concerns (e.g., hydronephrosis), a blood test called a basic metabolic panel (BMP) will be done to assess kidney function. Other imaging studies like a contrast-enhanced CT, intravenous pyelography (IVP), or magnetic resonance urography without contrast (for pregnant patients) may be required if a patient has a complex urinary tract anatomy or staghorn stones. Finally, additional studies may be needed for anesthesia clearance, like an electrocardiogram (ECG). How to Prepare If your surgery is scheduled, your healthcare provider will give you information on how to prepare. Following these instructions is important. Note, however, that urgently needed surgeries will not be postponed due to a lack of preparation. Location Kidney stone surgery is performed in a hospital, surgical center, surgeon's office, or emergency room by a urologist. What to Wear You will change into a hospital gown upon arrival, so wear loose-fitting clothes that are easy to remove. Leave all valuables, including jewelry, at home. Food and Drink Avoid eating or drinking after midnight on the eve of your surgery. Medications Stop taking certain medications that may cause bleeding; ask your healthcare provider for guidance on a timeframe for this. Before surgery, tell your healthcare provider all of the drugs you are taking including prescription and over-the-counter medications, dietary supplements, herbal remedies, and recreational drugs. What to Bring On the day of your surgery, be sure to bring: Your driver's license and insurance cardList of your medications If you are staying overnight in the hospital, remember to pack a bag with: Personal items (e.g., toothbrush, hairbrush)Comfort items (e.g., hand cream, earplugs, a tablet)Medical items (e.g., inhaler or eyeglasses) Arrange for someone to drive you home once you are discharged. Pre-Op Lifestyles Changes Stop smoking prior to surgery to lower your risk for surgical complications. The longer you stop smoking, the greater the benefits. What to Expect on the Day of Surgery On the day of your surgery, you will arrive at the hospital or surgical center/office and check-in. Before the Surgery You will be taken to a pre-operative room where you will change out of your clothes into a hospital gown. A nurse will then review your medication list, record your vitals, and place an intravenous (IV) line into a vein in your arm or hand. Depending on the surgery you are undergoing, your healthcare provider may give you an antibiotic through your IV (or to be taken by mouth) at this time. Your surgeon will come to greet you and briefly review the operation. From there, you will be wheeled into the operating room on a gurney where the anesthesia process and surgery will begin. During the Surgery Kidney surgery may be performed under general or regional anesthesia, depending on the specific surgical procedure being performed. Regional anesthesia: The surgeon will inject a numbing medication into your spine. You may feel a stinging sensation as the medication is being injected. You will also probably be given a sedative to help you fall asleep during the surgery. General anesthesia: The anesthesiologist will administer inhaled or intravenous medication to put you to sleep. Once asleep, a breathing tube called an endotracheal tube will be inserted. This tube is connected to a ventilator which will help you breathe during the surgery. Surgical Procedure Anesthesia Used Typical Duration of Surgery Shock wave lithotripsy General or Regional 45 to 60 minutes Ureteroscopy General 1 to 3 hours Percutaneous nephrolithotomy General 3 to 4 hours Laparoscopic and robot-assisted surgery General 90 to 100 minutes Open surgery General 1.5 hours The steps of kidney stone surgery depend on the surgical technique/approach being used. Since ureteroscopy is a common surgery used to remove kidney stones, especially those that have failed shock wave lithotripsy, let's review the basics steps of that surgical procedure as an example: Visualization: The surgeon will pass a ureteroscope through the urethra and bladder and up toward the ureter and kidney. Balloon dilators may be used to widen the ureter, depending on the precise location of the stone.Extraction: If the stone is small enough, forceps or a wire basket device will be used to remove it in one piece. If the stone is too large, it will be broken into pieces with a laser and allowed to pass naturally through the urine.Stone analysis: Any stone material is sent to a laboratory for examination of its chemical composition.Stent placement: Sometimes, a stent will be placed in the ureter, especially if it is swollen from the procedure. By keeping the ureter open with this small tube, the surgeon can make sure that urine drains well and that stone fragments pass easily if needed. After the Surgery In the recovery room, a nurse will monitor your vital signs. Once you are fully awake and alert, you will be discharged home. If you are staying in the hospital, you will be wheeled to a hospital room. Recovery If your stone was broken into fragments, you may be given a medication called Flomax (tamsulosin). This helps facilitate the passing of the stone fragments out of the body in your urine. You will likely be asked to strain your urine through a filter to capture the stone fragments. Save any you find and bring them to your healthcare provider. The fragments will be sent off to a pathology lab for chemical analysis. Symptoms You Might Experience Some symptoms you may experience after kidney stone removal can seem alarming, but are usually normal. These include: Pain and nausea: These are common and occur as kidney stone fragments pass through your urinary tract and out of your body. Your healthcare provider may prescribe you pain and anti-nausea medications to ease these symptoms. Mild discomfort at incision sites, if any: Ask your practitioner about how to best care for these sites, including when you can safely shower. Blood in urine; painful urination (dysuria): This may occur after ureteroscopy with ureteral stent placement. Most stents are removed around one to two weeks after surgery, but be sure to confirm the timing of this with your healthcare provider. Soreness at tube insertion site: If you have a nephrostomy tube placed, be sure to follow your practitioner's instructions for keeping the skin around the tube dry and clean. Of course, if you are ever concerned about any symptoms you are experiencing—especially if they persist for more than a few days—call your surgeon. When to Seek Medical Attention Call your surgeon right away or go to the emergency room if you experience any of the following symptoms:Fever or chillsSevere pain, which may be a sign of a blockage or other surgical complicationHeavy bleeding or blood clots in your urine, which may be a sign of bleeding around the kidneySigns of a urinary tract infection like burning when you urinate or foul-smelling urineSigns of a wound infection like increased warmth/redness/swelling/tenderness around your incision site(s) Activity The overall recovery timeline from kidney stone surgery depends on the type of surgery performed. Generally speaking though, you can likely return to your normal activities after about two to three days if you underwent shock wave lithotripsy or a ureteroscopy. Recovery from the other procedures takes longer. For example, expect around one to two weeks for percutaneous nephrolithotomy and four to six weeks for open surgery. Long-Term Care Around two to three months after your kidney stone surgery, your healthcare provider (usually a kidney specialist called a nephrologist) will order an imaging test. This is done to ensure that you are completely stone-free and that all stone fragments have been removed. In addition, based on the chemical analysis of your stone, your practitioner will devise a plan for you to help prevent future stones from forming. Three key stone-prevention strategies include: Drink around eight 8-ounces cups of water a day to continually flush out your urinary tract. If you are not used to drinking that much water, start slow and gradually increase your consumption every day. Taking certain medications, as recommended by your healthcare provider, depending on the type of stone you had (e.g. a thiazide diuretic or potassium citrate) Changing your diet, again depending on the type of stone you had: For instance, you may be asked to reduce your intake of animal protein and sugar-sweetened foods and drinks. You may also be asked to up your fruit and vegetable intake. Possible Future Surgeries Office-based procedures are typically used to remove a ureteral stent or nephrostomy tube (under local anesthesia). Future surgical procedures may be warranted if stone fragments are left behind or if a stone forms again. A Word From Verywell Kidney stones are common and may occur because of different factors including genetics, diet, fluid intake, and medications, to name a few. If you or a loved one has a stone that needs to be surgically removed, be sure to carefully review your options with your urologist. Choose the surgery that is going to be the most effective and comfortable for you. 1:29 18 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Preminger GM. Kidney stones in adults: Surgical management of kidney and ureteral stones. Goldfarb S, O'Leary MP eds. UpToDate. Waltham, MA: UpToDate. Neisus A, Lipkin ME, Rassweiler JJ, Preminger GM, Knoll T. Shock wave lithotripsy; the new phoenix? World J Urol. 2015 Feb;33(2):213-21. doi:10.1007/s00345-014-1369-3 Johns Hopkins Medicine. Ureteroscopy. National Kidney Foundation. Ureteroscopy. Assimos D, Krambeck A, Miller NL et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, Part II. J Urol. 2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091 Mayo Clinic. Percutaneous nephrolithotomy University of Michigan Medicine. Open Surgery for Kidney Stones. National Kidney Foundation. Kidney Stone Treatment: Shock Wave Lithotripsy. Johns Hopkins Medicine. Lithotripsy. De Coninck V, Keller EX, Somani B et al. Complications of ureteroscopy: a complete overview. World J Urol. 2020 Sep;38(9):2147-2166. doi:10.1007/s00345-019-03012-1 de la Rosette J, Assimos D, Desai M et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011 Jan;25(1):11-7. doi:10.1089/end.2010.0424 Assimos D, Krambeck A, Miller NL. Surgical Management of Stones: American Uological Association/Endourological Society Guideline, Part II. J Urol. 2016 Oct;196(4):1161-9. doi: 10.1016/j.juro.2016.05.091 University of Utah. What to Expect At Your Kidney Stone Surgery. Pierre S, Rivera C, Le Maître B et al. Guidelines on smoking management during the perioperative periods. Anaesth Crit Care Pain Med. 2017 Jun;36(3):195-200. doi:10.1016/j.accpm.2017.02.002 Wollin DA, Joyce AD, Gupta M et al. Antibiotic use and the prevention and management of infectious complications in stone disease. World J Urol. 2017 Sep;35(9):1369-1379. doi: 10.1007/s00345-017-2005-9 Pais VM, Smith RE, Stedina EA, Rissman CM. Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis. J Urol. 2016 Nov;196(5):1458-1466. doi:10.1016/j.juro.2016.05.109 Fulgham PF, Assimos DG, Pearle MS, Preminger GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol. 2013 Apr;189(4):1203-13. doi:10.1016/j.juro.2012.10.031 Harvard Health. 5 steps for preventing kidney stones. Additional Reading Cakici OU, Ener K, Keske et al. Open stone surgery: a still-in-use approach for complex stone burden. Cent European J Urol. 2017 Jun 30; 70(2): 179–184. doi:10.5173/ceju.2017.1205 Johns Hopkins Medicine. Percutaneous nephrolithotomy (PCNL). Torricelli FCM, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E. Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta-analysis of randomized controlled trials. Int Braz J Urol. 2016 Jul-Aug; 42(4): 645–654. doi:10.1590/S1677-5538.IBJU.2015.0696 By Laura Newman Laura Newman is an award-winning journalist with expertise in clinical medicine, health policy, urology, oncology, neurology, and targeted therapies. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. 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