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Kidney Stone Treatment Options: Medicines, URS, RIRS or PCNL?

Writer: Chandresh Digital
Chandresh Digital
6 hours ago
4 min read

Kidney stones are common in India, and Delhi's hot summers and low water intake add to the risk. If you have been told you have a stone, you may be wondering whether it will pass on its own or needs a procedure, and what terms like URS, RIRS and PCNL mean. This guide explains the main options and how urologists usually choose between them.


Symptoms that need attention

  • Severe, cramping pain in the side or back that may spread to the lower abdomen or groin (renal colic)

  • Blood in the urine

  • Nausea or vomiting

  • A frequent or urgent need to pass urine, or burning while passing urine

Seek urgent care at the nearest hospital emergency department, or call 112, if you have:

  • Fever or chills with stone pain, which may mean an infected, blocked kidney

  • Pain that cannot be controlled

  • Very little or no urine output

  • A stone with only one functioning kidney


How a stone is assessed

  • Imaging: a urologist will usually advise an ultrasound and/or a non-contrast CT scan (CT KUB). CT shows the stone's exact size, position and density.

  • Blood tests: to check kidney function.

  • Urine tests: to look for infection.

These details guide treatment more than anything else.


Option 1: Waiting and medicines (medical expulsive therapy)

Many small stones, especially those under about 5 mm in the ureter (the tube from kidney to bladder), pass by themselves within a few weeks. Your doctor may prescribe:

  • Pain relief

  • Medicines that relax the ureter (for example, alpha-blockers), to help the stone pass

  • Plenty of fluids, unless you are advised otherwise

You will need follow-up imaging to make sure the stone has passed and the kidney is not blocked. Some stones, such as uric acid stones, can be dissolved with medicines that change the acidity of the urine. Read more in kidney stone medicine: what works and when surgery is needed.

Be careful with "stone-dissolving" remedies that claim to clear all stones. Large or calcium stones generally do not dissolve, and a blocked kidney can be damaged if treatment is delayed.


Option 2: URS (ureteroscopy) with laser

  • What it is: a thin telescope (ureteroscope) is passed through the urethra and bladder into the ureter, with no external cuts. A laser fibre breaks the stone, and the fragments are removed or left to pass.

  • When it is used: commonly for ureteric stones that do not pass or that cause blockage or infection.

  • Afterwards: a temporary soft tube (DJ stent) is often placed between kidney and bladder and removed after a few days or weeks.


Option 3: RIRS (retrograde intrarenal surgery)

  • What it is: a flexible ureteroscope is passed up through the urinary passage into the kidney itself, and the stone is broken with a laser (laser lithotripsy).

  • Who it may suit: kidney stones up to about 2 cm, including stones in parts of the kidney that are difficult to reach. It can also suit patients who should avoid a puncture through the back.

  • The procedure: it is done under anaesthesia, usually with a short hospital stay. A temporary stent may be placed.


Option 4: PCNL (percutaneous nephrolithotomy)

  • What it is: a small tract is made through the back directly into the kidney, and the stone is broken and removed through it. Mini-PCNL uses a narrower tract.

  • Who it may suit: usually large stones (often more than about 2 cm), staghorn stones, or very hard stones.

  • Hospital stay: a short stay is needed.


What about ESWL (shock-wave lithotripsy)?

ESWL focuses shock waves on a stone from outside the body to break it into fragments that are then passed in the urine. It may be considered for selected kidney stones that are not very hard, but it is less effective for hard stones and for stones in the lower part of the kidney, and more than one session may be needed. ESWL is not offered at THE CLINICS. If your urologist feels ESWL is the most suitable option for you, they will explain where it can be done.


Which treatment is right for you?

No single procedure suits everyone. The urologist considers:

  • The size, number, position and hardness of the stone

  • Whether there is infection or blockage

  • Kidney anatomy and function

  • Your other health conditions, and any blood-thinning medicines

  • Your preferences

A rough guide to the options often considered:

  • Small ureteric stone, pain controlled, no infection: medicines and observation

  • Ureteric stone not passing, or blocking the kidney: URS with laser

  • Kidney stone up to about 2 cm: RIRS (ESWL is sometimes considered elsewhere)

  • Large or staghorn kidney stone: PCNL or mini-PCNL, sometimes combined procedures

Your urologist will explain the expected benefits, risks (such as bleeding, infection and residual fragments) and recovery for the option recommended.


Recovery and stent care

  • Many patients return to light work within a few days after URS or RIRS. Recovery after PCNL usually takes a little longer.

  • A DJ stent can cause mild discomfort, frequency or blood in the urine until it is removed. Do not miss the stent removal date.


Preventing stones from coming back

Stones often recur, so prevention matters:

  • Drink enough water that your urine is pale. See how much water should you drink to prevent kidney stones?

  • Reduce salt, and limit packaged and processed foods.

  • Do not cut out calcium-rich foods unless advised. Moderate animal protein instead.

  • Ask about stone analysis and metabolic tests if you have repeated stones.


Kidney stone care at THE CLINICS, South Delhi

Our urologists, Dr Bipul Agarwal (DMC Reg. No. 81020; Tuesday, Thursday and Saturday, 6 to 8 pm) and Dr Saurabh Girotra (DMC Reg. No. 10402; Monday, Wednesday and Friday, 6 to 8 pm), see patients with kidney and ureteric stones at THE CLINICS MISC, Hauz Khas. The team offers:

  • Assessment, imaging review and medicines

  • Laser procedures (URS and RIRS)

  • PCNL, where needed

All procedures are done at THE CLINICS MISC, Hauz Khas. THE CLINICS MISC Hauz Khas is a six-bed surgical facility with a four-bed HDU and two private rooms, all with ICU-enabled beds, a modular operation theatre, laser systems, a 4K HD laparoscopic system and a dedicated surgical team. Any cost estimate is shared after examination. Learn more on our kidney stone treatment page.

Call or WhatsApp +91 9217381353 or book a consultation.


This article was prepared with AI assistance. Medically reviewed by Dr Saurabh Bansal (Delhi Medical Council Reg. No. 37887). It is for general information and is not a substitute for medical advice. Treatment decisions should be made with your doctor after assessment.

 
 
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