Few medical problems are as instantly unforgettable as the pain of a kidney stone. But while the fear of surgery often follows the diagnosis, most stones don’t actually require it. According to Dr Aakil Khan, Consultant Urologist at KIMS Hospitals, Thane, treatment depends entirely on the stone’s size, location, and the symptoms it causes.
“Some stones are so small they pass naturally with urine,” Dr Khan explains. “Others, if left untreated, can block the urinary tract or damage the kidney.” The key lies in identifying which is which and acting early.
Do all kidney stones need surgery?
Not always. Kidney stones come in all shapes and sizes, and their behaviour varies widely.
Tiny stones, sometimes smaller than a grain of rice, can pass naturally through urine, often with mild discomfort and increased water intake.
However, larger stones may become lodged in the ureter (the tube connecting the kidney and bladder), leading to sharp pain, infection, or even urinary blockage. “Surgery is reserved for cases where the stone is too big, keeps recurring, or begins to threaten kidney function,” says Dr Khan.
How doctors decide if surgery is needed
The position and size of the stone and the degree of symptoms decide the next course of action.
- Less than 5 mm: Typically pass on their own with adequate hydration and bed rest.
- 5–7 mm: May pass on their own, but sometimes require medical support.
- Over 7 mm: Unlikely to move without assistance; surgical or minimally invasive procedures are usually needed.
Repeated urinary infections, severe pain, or kidney obstruction are also deciding factors. “Our aim is always to avoid surgery when possible,” Dr Khan notes, “but to act quickly when the kidney is at risk.”
Non-surgical treatment options
For small stones, simple measures can be surprisingly effective:
- Hydration: Drinking 2.5–3 litres of water daily helps flush out tiny stones.
- Medication: Certain medicines relax the ureter, easing passage.
- Diet changes: Cutting down on salt and high-oxalate foods (such as spinach, nuts, and chocolate) reduces recurrence.
- Follow-up: Schedule regular ultrasound or CT scans to monitor if the stone is getting smaller or passing.
“Most stones, if small, will pass naturally with patience and proper care,” says Dr Khan.
When surgery becomes the best option
When a stone grows large, causes unbearable pain, or blocks urine flow, surgery may be the safest route. Thankfully, modern techniques have transformed this experience.
Laser lithotripsy and shock-wave therapy (ESWL) are now routine treatments that employ bursts of energy to crush the stone into tiny pieces that can pass out naturally. These treatments are minimally invasive, require little or no incision, and offer faster recovery.
“Patients often walk out within a day or two,” Dr Khan explains. “The procedures are safe, precise, and highly effective.”
Kidney stones are painful, but panic isn’t necessary. The majority can be managed naturally with fluids, medication, and sensible diet changes. Only a small fraction requires surgery, and when they do, the outcomes are excellent.
As Dr Khan sums up, “Knowing when to intervene and when to wait is the real art of treatment. The goal isn’t just removing the stone, it’s preserving kidney health for the long term.”
