How are large stones in nephrolithiasis treated?

Updated: Sep 16, 2021
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Larger stones (ie, ≥7 mm) that are unlikely to pass spontaneously require some type of surgical procedure. In some cases, hospitalizing a patient with a large stone to facilitate surgical stone intervention is reasonable. However, most patients with acute renal colic can be treated on an ambulatory basis.

About 15-20% of patients require invasive intervention due to stone size, continued obstruction, infection, or intractable pain. Techniques available to the urologist when the stone fails to pass spontaneously include the following [51] :

  • Stent placement
  • Percutaneous nephrostomy
  • Extracorporeal shockwave lithotripsy (ESWL)
  • Ureteroscopy (URS)
  • Percutaneous nephrostolithotomy (PNCL) or mini PNCL
  • Open nephrostomy - more historical
  • Anatrophic nephrolithotomy - typically now done increasingly by laparoscopic or robotic approach

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