Kidney stones: symptoms, diagnosis and when surgery is needed

Kidney stones are common, and larger stones can be very painful. Most stones pass on their own or can be treated without an operation, but some need to be removed. This guide covers the symptoms, how doctors find stones, the warning signs that need urgent care, and when surgery may be needed.

What is a kidney stone?

A kidney stone is a hard, pebble-like lump that forms in the kidney. It forms when urine (pee) has high levels of certain minerals, such as calcium, oxalate or phosphorus. These form tiny crystals that can grow into a stone over weeks or months.

Stones can be as small as a grain of sand or as large as a pea, and sometimes larger. A small stone may pass out in the urine without you noticing. A larger stone can get stuck in the ureter, the tube that carries urine from the kidney to the bladder. A stuck stone can block the flow of urine and cause pain.

Types of stone

Calcium stones are the most common type.
Uric acid stones are more common in men than in women and can occur in people with gout.
Struvite stones are linked to repeated urine infections and can grow very large.
Cystine stones form in people with cystinuria, a condition that runs in families.

Knowing the type of stone helps your doctor plan how to lower your risk of new stones. That is why you may be asked to strain your urine to catch a stone so it can be tested.

Who gets kidney stones?

The biggest risk factor is not drinking enough fluid. When you drink too little, your urine becomes very concentrated. You are also more likely to get stones if:

someone in your family has had kidney stones
you have had repeated urine infections
you have had a kidney stone before
you have conditions such as gout or certain diseases of the small intestine

Where you live may matter too. A review of research across Asia, published in the Asian Journal of Urology in September 2018, described a stone-forming belt running across West, South and Southeast Asia. In those countries, between 5% and 19.1% of people had stones, compared with 1% to 8% in other parts of Asia.

Stones often come back. A review published in Frontiers in Medicine in July 2025 said that almost half of people who have had a stone get another within 5 to 10 years.

Symptoms

Small stones may cause no symptoms. Symptoms usually start when a stone moves down the ureter and blocks the flow of urine. Common symptoms include:

Severe pain in your side, lower back or the side of your tummy. The pain often comes and goes in waves.
Pain that spreads to the groin, the testicles in men, or the area around the vagina in women
Feeling sick or vomiting
Pink, red or brown urine, caused by blood (doctors call this haematuria)
Needing to pass urine often, or pain or burning when you pass urine
Cloudy or bad-smelling urine
Sweating
Fever or chills

These symptoms can also be caused by other conditions, some of them serious. A doctor needs to examine you to be sure.

Warning signs: get urgent medical care

Go to a hospital emergency department straight away if you have, or think you have, a kidney stone and:

You have a fever, chills or shivering. A stone that blocks the ureter can lead to a kidney infection, which needs urgent treatment.
The pain is severe and will not go away, or it is getting worse or is not controlled by pain relief
You cannot pass urine, or can pass only a very small amount
You keep vomiting
You feel very weak or very unwell

See a doctor the same day if you have blood in your urine or cloudy, bad-smelling urine.

Do not wait at home to see whether a fever or severe pain passes. Kidney stones that cause severe pain or a high temperature need urgent medical help.

If you are not sure how urgent your symptoms are, you can call Shasthyo Batayon 16263, the government health call centre run by the Directorate General of Health Services. It runs 24 hours a day. You can get advice from a doctor or ask where the nearest hospital is. In an emergency, go to hospital rather than waiting on the phone.

How kidney stones are diagnosed

A doctor will ask about your symptoms, any conditions you have, any medicines you take, your diet, and whether you or anyone in your family has had stones before. They will also examine you. Tests may include:

Urine test: checks for blood, infection and crystals.
Blood tests: check how well your kidneys are working and measure calcium, phosphorus, uric acid and salts in the blood.
Ultrasound scan: uses sound waves to see the kidneys. It involves no radiation, so it is the usual scan for pregnant women and children.
CT scan: a detailed X-ray scan that shows the size and position of a stone. It is usually used for adults with severe pain.
X-ray of the abdomen: can show stones and may be used to check whether a stone has passed.
Stone analysis: if you pass a stone, it can be tested to find out what it is made of.

Treatment without surgery

Many small stones pass on their own, though this can take a few weeks and can still be painful. While you wait, you will usually be told to drink plenty of water. Your doctor may offer medicines for pain, for sickness, or to help the stone pass in your urine. Your doctor decides which medicines suit you.

Some people with very severe pain need to stay in hospital and get fluids through a drip. When the pain stops, that does not prove the stone has gone. Your doctor may ask you to catch the stone when it passes, or arrange a follow-up X-ray to check.

When surgery is needed

MedlinePlus, from the US National Library of Medicine, says surgery is often needed if:

The stone is too large to pass on its own
The stone is growing
The stone is blocking the flow of urine and causing infection or kidney damage
The pain cannot be controlled
There is a urine infection or fever

Today most treatments are much less invasive than in the past. The type of procedure depends mainly on the size, type and position of the stone.

Procedure	What it involves
Shock wave lithotripsy (SWL or ESWL)	A machine outside the body sends shock waves to the stone and breaks it into small pieces. The pieces then pass out in the urine.
Ureteroscopy	A thin telescope is passed through the urine passage and bladder into the ureter. The stone is removed, or broken up with a laser so the pieces can pass. It is done under general anaesthetic, which means you are asleep.
Percutaneous nephrolithotomy (PCNL)	A small cut is made in the back and a thin telescope is passed into the kidney to remove large stones. It is done under general anaesthetic.
Open surgery	Rarely needed. It is used only when other methods do not work or are not possible.

Sometimes a blocked kidney holding infected urine needs a procedure to drain it. Ask your surgeon to explain the benefits, risks and recovery for any option they suggest.

Which doctor should you see?

Hospital emergency department: for severe pain, fever, repeated vomiting or being unable to pass urine.
General practitioner or medicine doctor: for milder symptoms, first tests and referral.
Urologist: a surgeon who treats problems of the kidneys, ureters, bladder and prostate. Urologists treat stones that need a procedure or surgery.
Nephrologist: a kidney medicine specialist. You may be referred to one if your kidneys are not working well or you keep getting stones.
Paediatric urologist or paediatric nephrologist: for children with stones.

Preventing stones from coming back

Drink plenty of fluid through the day, unless a doctor has told you otherwise.
Ask your doctor whether you need to change your diet. The advice depends on your stone type and may cover salt, animal protein, calcium or oxalate.
Go to your follow-up appointments. Your doctor may arrange blood and urine tests to work out how to prevent more stones.
If you have another long-term health condition, ask your doctor how much fluid is right for you.

When a doctor treats them, kidney stones rarely cause permanent damage. Get help early, and don’t ignore a fever or not being able to pass urine.

This article is for general information. It does not replace advice from a doctor who has examined you.

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Sources

This article is general information, not medical advice. It was written by AI from the sources above. It did not pass the automatic check, and an administrator chose to publish it; no doctor or editor has reviewed it. For a diagnosis or treatment, see a registered doctor.