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Medium Kidney Stones – 5-20 mm

Medium sized stones in the kidney (5-20mm diameter) generally require treatment even if they are not causing any symptoms. This is because these calculi are unlikely to pass spontaneously and very likely to cause problems at some point in the future. These stones may cause pain, bleeding, urinary infections or more rarely kidney damage.

The treatment options for kidney stones 5-20mm are:

  • Extracorporeal Shockwave Lithotripsy (ESWL).
  • Ureteropyeloscopy.
  • Percutaneous Nephrolithotomy – usually for larger stones.
  • Observation - if the patient is too frail for an operation.

These stones are generally treated in one of two ways: Extracorporeal Shockwave Lithotripsy (ESWL) or Ureteropyeloscopy. The decision as to which of these two options is most appropriate is complex and needs to be individualised for each clinical situation. There is no one “best” treatment for kidney stones and both of these treatment modalities have their advantages and disadvantages. Here is a table which summarizes the differences.

  ESWL Ureteropyeloscopy
Mechanism Sound waves through skin break the stone, pieces need to pass naturally Telescope through urethra, stone visualized with laser fragmentation then removal of stone
Anesthetic General Anesthetic General Anesthetic
Time 30-45 min 45-120 min
Hospitalisation Day case Day case or overnight
Complexity Less complex More complex
Safety Very safe Very safe
Need for stent Stent rarely used Usually needs a stent
Procedures needed Usually one Usually two
Success Rate 60-80%, less if larger 95%
Risk of renal colic Yes, from passing fragments No, fragments are removed
Stone Analysis Not possible usually Yes, fragments analysed