Kidney Stone Surgery: Types, Risks, and Recovery

Medically Reviewed by Jabeen Begum, MD on June 07, 2024
Written by Kathryn Whitbourne
11 min read

Kidney stones are hard deposits made from minerals such as calcium or waste products such as uric acid. They start small in your kidneys but can grow bigger as more minerals stick to them. Kidney stones can be as tiny as a grain of sand or the size of a pea. Sometimes, they can be as big as golf balls. They're usually yellow or brown in color and may be smooth or jagged. 

Kidney stones are quite common. In the U.S., around 11% of men and 6% of women have had kidney stones at least once in their lives. 

The main types of kidney stones are:

  • Calcium stones
  • Uric acid stones
  • Struvite stones
  • Cystine stones

Many kidney stones pass on their own without treatment. Others may need to be removed with surgery.

You might need surgery to take out kidney stones if:

  • The stone is very large and can't pass on its own.
  • You're in a lot of pain.
  • The stone is blocking the flow of urine out of your kidney.
  • You've had many urinary tract infections (UTIs) because of the stone.

These four treatments can be used on your kidney stones:

  • Shock wave lithotripsy 
  • Ureteroscopy
  • Percutaneous nephrolithotomy or percutaneous nephrolithotripsy 
  • Open surgery

Here’s more about each of these:

SWL is the most common kidney stone treatment. It involves using high-energy shock waves to break up your stones. It works best for small or medium stones (those under 2 centimeters, or 1 inch) and is noninvasive, which means no cuts are made in your skin.

During this procedure, you lie on a table. You'll get medicine to limit any pain or discomfort.

The doctor uses an X-ray or ultrasound to find the stone (or stones) in your kidney. Then they aim high-energy shock waves at your kidney from the outside. These waves go through your skin and break up your stone into tiny pieces.

The doctor might put a tube called a stent into your ureter, a tube connecting your kidney to your bladder that urine flows through. This stent helps the pieces of stone pass. SWL takes about an hour. You'll usually go home on the same day.

Afterward, you'll drink lots of water to flush the stone pieces out in your urine. You might have to pee through a strainer to catch pieces of the stone so a lab can test them.

Possible side effects of lithotripsy

The procedure can cause cramps or blood in your urine. More serious problems are less likely, but can include:

  • Bleeding around the kidney
  • Infection
  • Damage to the kidney
  • A stone blocking the flow of urine

Sometimes, stone fragments are left in the body and you might have to do the treatment again to get those out. 

 

This procedure is mostly used for treating small- to medium-sized stones in the ureters, though it can also remove stones from the kidneys. It's a good option for people who can't get shock wave lithotripsy because they're pregnant, very obese, or have to take blood thinners. 

Your doctor uses a thin, flexible telescope, called a ureteroscope, to find and remove stones. No cuts are made in your skin. You'll sleep through this procedure.

Your doctor will pass the scope through your bladder and ureter into your kidney to where your stone or stones are. They use a small basket to remove small stones. If the stones are larger, your doctor will pass a laser beam through the scope to break them up. You're usually able to go home on the same day.

Your doctor might place a stent in your ureter to help urine drain from your kidney into your bladder. You'll go back to your doctor after 4 to 10 days to have the stent taken out.

Some stents have a string on the end so you can pull them out yourself. Be sure to carefully follow your doctor’s instructions about taking out a stent yourself.

Possible ureteroscopy side effects

Possible problems after a ureteroscopy include:

  • Infection
  • Narrowing of the ureter
  • Bleeding

If you had your urinary tract reconstructed, you may not be able to have a ureteroscopy.

If your stone is large or SWL doesn't break it up enough, this surgery is an option. "Percutaneous" is a word meaning "through the skin," and this procedure involves passing a small tube through your skin to reach the stone and remove it.

You'll be given a sedative so that you won’t be awake during this surgery. Your surgeon will make a small cut in your back or side and place a tube into the kidney. Then they place a nephroscope (tiny camera) through the tube.

The surgery can be done in one of two ways:

Nephrolithotomy: Your surgeon finds and removes the stone through the tube.

Nephrolithotripsy: Your surgeon uses sound waves or a laser to break up the stone and then vacuums up the pieces with a suction machine.

The surgery takes 20 to 45 minutes. You'll typically have to stay in the hospital for a day or two afterward. Usually, a stent will have to stay in your kidney for a few days to help urine drain.

Your doctor might do an X-ray or ultrasound a few weeks later to see whether any parts of the stone are left. They might also send the stone fragments to a lab to find out what they're made of.

Generally, this treatment takes care of removing the stone so you're unlikely to need to come back for a second surgery.

Possible side effects of nephrolithotripsy

Risks from this surgery include:

  • Infection
  • Bleeding
  • Damage to the bladder, bowel, ureter, kidney, or liver

Open surgery is rarely done for kidney stones anymore. But if your stone is very large or it can't be removed or crushed with other treatments, this surgery might be an option.

Open surgery may also help if:

  • One of the stones is stuck in your ureter.
  • You're in a lot of pain.
  • The stone is blocking your urine flow.
  • You're bleeding or you have an infection.

You'll be given something to make you unconscious during the procedure. The surgeon will make a cut in your side and into your kidney. They will remove the stone through the opening. A stent is placed in the ureter to help urine drain. You may need to stay in the hospital for around 6 days. 

Possible side effects of open surgery

Risks include:

  • Infection
  • Severe bleeding
  • A hernia where the cut was made for your surgery
  • Damage to surrounding organs

Post-operative care will depend on the type of kidney stone removal surgery you had, but here are some general tips:

  • Your doctor will probably prescribe pain medication and an antibiotic to prevent infection. 
  • Drink lots of water and other liquids to help stone fragments come out. If your urine is a pale yellow color, you're drinking the right amount. Too little water makes your urine dark yellow.
  • You may see a small amount blood in your urine. This is normal. If you see a lot of blood, call your doctor.
  • Your doctor may ask you to strain your pee at home to collect any stones that come out. These can be sent to a lab to find out what types of stones they are, which can help with further treatment. It may take weeks to pass all your stones.
  • You'll need to rest for at least a day or two, depending on the type of kidney stone surgery you had. The doctor will tell you when you can resume normal activities and what to be careful doing.
  • If you had a stent put in, your doctor will remove it at your first follow-up visit, or they may explain to you how to remove it yourself. This depends on the kind of stent they put in. 

 

 

 

Recovery time varies with your type of surgery. 

  • Lithotripsy/SWL: 1-2 days
  • Ureteroscopy: 5-7 days
  • PCNL: 2-3 weeks, plus 1-4 nights in the hospital
  • Open surgery: 4-6 weeks, plus 6-9 days in the hospital

Call your surgeon or go to the emergency room if you have any of the following complications after your kidney stone surgery:

  • Fever
  • Blood in your urine becomes bright red or increases
  • Heavy bleeding in your drainage tube
  • Worsening pain
  • Nausea that lasts for days
  • Swelling or redness around your cut
  • Dizziness, chest pain, or shortness of breath

Can kidney stone surgeries cause scars?

Yes, PCNL and open stone surgery can cause scarring. Kidney surgery scars are also possible with lithotripsy and ureteroscopy but are far less likely. 

Depending on the type of stones you had, you may be able to stop them from coming back by changing your diet. In general:

  • Drink 6-8 8-ounce glasses of fluid each day. Most of this should be water, but citrus-based liquids like orange and grapefruit juices are good, as they contain citric acid, which can keep stones from forming. 
  • Reduce your amount of sodium. Many processed foods are high in sodium even if they don't taste salty. Aim for no more than 2,300 milligrams (about a teaspoonful) of sodium per day. If sodium added to your kidney stones, try to reduce it to 1,500 milligrams per day.
  • Limit animal protein. Eat less meat, chicken, fish, milk, cheese, and eggs, as these contain uric acid, which encourages stones to form. Replace some of this with plant-based protein, like beans and peas.
  • Aim for a healthy weight.

Calcium oxalate stones. Follow the general advice, plus avoid these foods, which can increase the amount of oxalate in your urine:

  • Nuts and nut products
  • Peanuts (these are legumes, not nuts, and are high in oxalate)
  • Rhubarb
  • Spinach
  • Wheat bran

Eat enough calcium.Calcium from food doesn't cause calcium stones. In fact, it actually blocks other substances that can cause stones. Since you have to cut back on dairy, get your calcium from fortified juices, cereals, breads, and some types of vegetables and beans. Avoid vitamin C and D supplements and fish oil. 

Calcium phosphate stones. In addition to the general advice, eat enough calcium. Calcium can prevent you from getting more calcium phosphate stones. Since you have to cut back on dairy, get your calcium from fortified juices, cereals, breads, and some types of vegetables and beans. Unlike people with calcium oxalate stones, you can replace some of your animal protein needs with nuts and peanuts.

Uric acid stones. Follow the general advice. You can replace some of your animal protein needs with nuts and peanuts. Losing weight if you're overweight is especially important if you have uric acid stones. Avoid foods high in the chemical purine, such as organ meats, oily fish (mackerel, sardines), and shellfish (lobster, shrimp). Eat less refined sugar.

Cystine stones. The most important change is to drink a lot of liquid, maybe even more than 6-8 glasses per day.

Struvite stones. These are caused by UTIs, so your diet doesn't play a big role. But you'll still want to drink a lot of water.

Talk to a dietitian or your doctor about how you should change your diet after kidney stone treatment. 

Yes. It's quite common for stones to show up again after your kidney stone removal procedure. The recurrence rate at 5 years is between 35% and 50%. Some risk factors for recurrence include:

  • Age (Younger people have more recurrence.)
  • Family history of kidney stones
  • Having hypertension
  • Race (Caucasians have more recurrence.)
  • Male sex
  • Being overweight
  • Having already had kidney stones
  • Having certain diseases, like gout, inflammation of the bowel, cystic kidney diseases, and recurring UTIs
  • Taking certain medications like water pills, calcium-based antacids, indinavir (for treating HIV), and topiramate (for treating seizures)

To lessen the chances of recurrence, treat any UTIs promptly, drink lots of fluids, watch your diet, and ask your doctor whether any medications you're taking could contribute to kidney stones. 

Hyperparathyroidism happens when the parathyroid glands make too much calcium. These four tiny glands, which are at the base of your throat, manage the balance of calcium and phosphate in your blood necessary for bone health and muscle movement. 

When calcium blood levels get too high, kidney stones are one complication. Post-menopausal women and people with very low vitamin D are most likely to have hyperparathyroidism.

High calcium levels can be seen in a routine blood test. If your doctor thinks hyperparathyroidism could be the reason for your kidney stones, they'll order an ultrasound, X-ray, or CT scan to be sure. Then they'll remove the gland or glands that are malfunctioning, leaving the rest intact. The remaining glands can continue regulating calcium and phosphate in your blood. 

Parathyroidectomy (removal of the nonworking parathyroid glands) is associated with 8.3% reduction in the risk of getting kidney stones, according to one study. Other studies have shown parathyroidectomy is linked to a similar or higher risk of kidney stones returning than for those who hadn't had the procedure. This could be because the people who had this surgery tended to already have more severe kidney stone disease.

Make sure you understand the risks and benefits of each of your treatment options.

Ask your doctor these questions:

  • What side effects can this surgery cause?
  • What are the odds that it will treat my kidney stone?
  • How long will I need to stay in the hospital afterward?
  • How long will it be before I can get back to normal activities? Is there any activity I should not do?
  • What will you give me to control pain after surgery?
  • Is there a chance I'll have to repeat the surgery?

There are lots of options for kidney stone surgery, including shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy/nephrolithotripsy. Open surgery is a fourth option that is rarely performed nowadays. The type of surgery you get depends on the size of your kidney stones and your health. All these surgeries run a risk of kidney stones coming back, so you'll need to watch your diet, drink lots of water, and check in with your doctor. 

Is kidney stone removal a serious surgery?

Complications after surgery to remove kidney stones are rare. Most of the time, symptoms are mild, but they can vary, depending on the type of surgery you had. Some types are more involved than others and so have a higher risk of complications.

Can you remove kidney stones without surgery?

Yes, the stones often pass through your body without surgery within 3-6 weeks. But the pain can be excruciating. If you're in pain, see your doctor. They can give you a very strong pain reliever.

What should I not do after kidney stone surgery?

Generally, you shouldn't lift heavy objects or do any strenuous exercise for at least 2 weeks. Don't swim for 3 weeks. Your doctor will advise you on what you can and can't do.

Can you die from kidney stones?

If your ureter is blocked by a kidney stone and this is not treated, you could get an infection, which could turn deadly. You could also get chronic kidney disease or have kidney failure.