Kidney Stone Treatment (RIRS, PCNL, ESWL)
Not every stone needs an operation, and not every wait is safe. The method is chosen from the stone's size, density and position — and removing the stone is only half the treatment.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 30–90 minutes depending on method
- Anesthesia
- General or spinal; usually sedation for ESWL
- Hospital stay
- Day case – 2 nights
- Stay in Türkiye
- 4–7 days
- Return to work
- 2–7 days
- Flight clearance
- Usually after the review appointment
About the condition
Kidney stones form when minerals in the urine crystallise and accumulate. A stone can sit silently inside the kidney; when it drops into the urinary tract it obstructs flow and causes severe flank pain (renal colic).
THE MOST IMPORTANT WARNING FIRST: flank pain accompanied by FEVER AND SHIVERING is an emergency. Infection behind an obstructed urinary tract can progress rapidly and may require urgent drainage. This is not a situation to manage by waiting for a clinic appointment.
Passing no urine at all, pain not controlled by medication, and vomiting that prevents you from drinking are also reasons to seek urgent care.
PAINLESS DOES NOT MEAN SAFE. Obstruction that develops slowly may cause no pain at all; the kidney dilates quietly and can lose function. For this reason a known stone is followed with imaging regardless of whether it causes symptoms.
The treatment is not chosen from one measurement. Size, density on CT, position within the kidney, the anatomy of the collecting system, your medication and your general condition are weighed together.
Who is it suitable for?
May be suitable
- Stones causing symptoms that are unlikely to pass on their own
- Recurrent episodes of colic
- Obstruction with dilatation of the kidney
- Stones together with recurrent urinary infection
- Deterioration of kidney function attributable to the stone
- People whose occupation makes a sudden episode of colic unacceptable (pilots, for example) — treatment may be considered even for a silent stone
May not be suitable
- Patients with untreated urinary infection: surgery is not scheduled until the culture is clear, and this rule is not relaxed
- Patients with small, asymptomatic stones that can be followed — unnecessary intervention is avoided
- Patients with uncorrected bleeding disorders, particularly for PCNL
- Pregnancy: imaging and treatment options differ and the plan is made separately
- For ESWL specifically: pregnancy, uncorrected bleeding disorders, and obstruction distal to the stone
Technology used
- Non-contrast CT — shows the size, position and density of the stone and is the basis of the choice of method
- Flexible ureteroscope — deflects within the kidney to reach the individual calyces
- Holmium laser — to dust or fragment the stone
- Percutaneous access under ultrasound or fluoroscopic guidance
- Stone baskets and access sheaths
- Chemical analysis of the passed or removed stone — the first step in preventing recurrence
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Initial assessment
Your non-contrast CT, renal function tests and urine culture are reviewed. The CT images are requested, not only the report: the density value is often absent from the report and is decisive in choosing the method.
- Day 1
Arrival and work-up
Examination, repeat imaging if required, blood and urine tests, anaesthetic assessment. If the urine culture grows an organism, the procedure is postponed and the infection treated first.
- Day 2
Procedure
Performed according to the chosen method. RIRS involves no incision; PCNL uses a track of about a centimetre in the back; ESWL is applied from outside the body.
- Day 3
Discharge
Most patients are discharged the following day. If a stent has been placed, the symptoms it causes are explained.
- Days 4–6
Review and flying clearance
Stone clearance is assessed with imaging. If a stent is in place, when and where it will be removed is planned in writing — the detail most often overlooked for patients travelling from abroad.
Method comparison
| Criterion | RIRS (laser) | PCNL (percutaneous) | ESWL (shock wave) |
|---|---|---|---|
| Access | Natural urinary passage, no incision | About a 1 cm track in the back | None; applied externally |
| Stone size it suits | Small and moderate | Large and branched | Small |
| Effect of hardness | Hard stones take longer | Little affected | Success falls with hard stones |
| Lower pole stones | Fragments may drain poorly | Cleared directly | Fragments may remain |
| Anaesthesia | General or spinal | General | Usually sedation |
| Hospital stay | Day case–1 night | 1–2 nights | Day case |
| Main risk | Ureteric injury, stricture | Bleeding | Fragments obstructing the ureter |
| On anticoagulants | More suitable | Higher risk | Not suitable |
| Single-session clearance | Falls as the stone grows | Highest | Often needs several sessions |
The table is a guide; the decision is made from the CT and the whole clinical picture, not from one row. For a patient travelling from abroad the likelihood of needing a second session matters especially, because it means either a longer stay or a second journey — ask about it in advance.
Risks
- FEBRILE INFECTION: the complication to take most seriously with either procedure. This is why a clear urine culture beforehand is mandatory. Report fever, shivering or malaise after the procedure without delay
- BLEEDING: higher with PCNL because a track is made through the kidney. Transfusion or a further procedure is occasionally required
- URETERIC INJURY AND LATER STRICTURE: reported with RIRS from the passage of instruments
- Incomplete clearance requiring a second session — particularly for larger stones and lower pole stones
- Fragments lining up in the ureter and obstructing it after ESWL
- Stent symptoms: urinary frequency, flank discomfort, blood in the urine
- Rarely, involvement of the pleura or adjacent organs during PCNL
- Temporary blood in the urine and stinging — these are expected
Alternatives
- Medical expulsive therapy — for small ureteric stones, allowing the stone to pass with medication and fluids
- Observation — for small, asymptomatic stones that do not threaten the kidney. Observation means imaging; absence of symptoms alone is not enough
- ESWL — for stones of suitable size, position and density, with nothing entering the body
- RIRS — through the natural urinary passage, with no incision
- PCNL — single-session clearance for large and branched stones
- Laparoscopic or open surgery — now uncommon, for selected cases with associated anatomical problems
From our patients
- Ziver D.★★★★★
“Yıllardır böbreklerimden rahatsızlık yaşıyordum, çok sayıda doktora gittim ama hiçbirinden net bir sonuç alamadım — ta ki Müslüm hocayı bulana kadar. Allah ondan razı olsun. İlgisine, bilgisine, tecrübesine tebrik ediyorum. İyi ki varsınız Müslüm hocam. Yanınızdaki Şefkan Bey’e de teşekkürü borç bilirim, her şey için sağ olun.”
March 2023
Recovery
First 48 hours
Blood in the urine and stinging are expected. Drink plenty of fluids. Seek care immediately for fever, shivering or inability to pass urine.
Week 1
Colicky pain can occur as fragments pass after ESWL or RIRS. A pain relief plan is given in advance. Avoid strenuous exercise.
While the stent is in
Frequency, flank discomfort on voiding and blood in the urine are usual and resolve when the stent is removed. Knowing these symptoms are expected makes the period considerably easier.
First 2 weeks after PCNL
The access site is tender. Avoid lifting; wound care is explained before discharge.
Weeks 4–12
Stone clearance is confirmed with imaging. After ESWL this is not assessed early, since fragments may take weeks to pass.
Long term
Fluid intake and diet are planned individually from the stone analysis and any metabolic assessment. Skipping this step is why stones recur.
Frequently asked questions
Does every kidney stone need surgery?
No. Small stones that cause no symptoms and do not threaten the kidney can be observed, and many small ureteric stones pass with medication and fluids. Intervention is considered when there are symptoms, obstruction, infection or deterioration in kidney function.
I have no pain, so there is no hurry — is that right?
That assumption is dangerous. Obstruction that develops slowly may cause no pain, while the kidney quietly dilates and loses function. If you have a known stone, continue imaging follow-up even without symptoms.
When should I go to an emergency department?
Without delay if flank pain is accompanied by fever and shivering: infection behind an obstruction can progress rapidly. Passing no urine at all, pain not relieved by medication and vomiting that prevents drinking are also reasons to attend urgently.
Which method is right for me?
The decision comes from the size of the stone, its density on CT, its position in the kidney, the anatomy of your collecting system, any anticoagulants you take and your general condition. Lower pole stones in particular are judged differently from stones of the same size elsewhere, because fragments drain poorly from there.
Will one session clear my stone completely?
Usually, for small and moderate stones. As the stone grows the chance of needing a second session rises, and ESWL often requires more than one. If you are travelling from abroad, ask about this and about its effect on the length of your stay.
Will I need a stent, and for how long?
A temporary stent is often placed after these procedures to secure drainage. With a stent in place, frequency, flank discomfort and blood in the urine are usual and resolve on removal. Establish in writing before you leave how long it stays, and who will remove it and where.
Is the procedure painful?
It is performed under anaesthesia or sedation, so you feel nothing at the time. Afterwards there can be stinging, blood in the urine and colicky pain as fragments pass; a pain relief plan is provided in advance.
I take blood thinners — can I have this treatment?
This directly affects which method is chosen: PCNL, which creates a track through the kidney, carries more risk in these patients, and RIRS comes to the fore. Do not stop any medication on your own; send your complete medication list with your enquiry so the plan is made before you travel.
Why did I form a stone, and will it come back?
If nothing changes, stones tend to recur. The stone you pass or that is removed should be analysed, with urine testing and, where you form stones repeatedly, metabolic assessment. Increasing daily fluid intake is the simplest and most neglected measure. Dietary advice depends on the stone type; there is no single list for everyone.
I live in a hot climate — does that matter?
Yes. Fluid lost through sweating concentrates the urine and favours stone formation. An intake that is adequate in a cool climate may not be enough in a hot one. This matters particularly for patients from the Gulf and similar regions.
When can I fly after the procedure?
Most patients are cleared after the review appointment. However, flying with a stent and arranging who will remove it at home require a separate plan; discuss that before you fix your travel dates.
What should I send before coming?
The images of your non-contrast CT (not just the report), renal function tests, a current urinalysis and culture, your full medication list and records of any previous stone treatment. Send any previous stone analysis too. With these it can be assessed, before you buy a ticket, which method suits you and whether one session is likely to be enough.
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This page is for general information only and is not a substitute for medical advice.
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Treatments in this category
ESWL: Shock Wave Lithotripsy from Outside the Body
Breaking the stone with sound waves delivered from outside, with nothing entering the body. It is non-invasive, but it does not suit every stone and a result in one session cannot be guaranteed.
Learn morePCNL: Percutaneous Surgery for Large Kidney Stones
A method in which the kidney is reached through an entry of about one centimetre in the flank and large stones are cleared in a single sitting. It is the standard approach for staghorn stones.
Learn moreRIRS: Kidney Stone Treatment with a Flexible Endoscope
A method in which the kidney is reached through the urinary passage, with no incision anywhere on the body, and the stone is turned to dust with a laser. Who is it suitable for, why is a JJ stent placed and what is recovery like?
Learn more