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Options in the management of renal and ureteral stones in adults

Glenn M Preminger, MD
Section Editors
Stanley Goldfarb, MD
Michael P O'Leary, MD, MPH
Deputy Editor
Albert Q Lam, MD


Considerable progress has been made in the medical and surgical management of nephrolithiasis over the past 20 years. Approximately 10 to 20 percent of all kidney stones require surgical removal, which is determined based upon the presence of symptoms and the size and location of the stones. Larger stones and proximal ureteral stones are less likely to pass spontaneously. (See 'Facilitation of stone passage' below and "Diagnosis and acute management of suspected nephrolithiasis in adults", section on 'Stone passage'.)

Stone removal is also indicated for pain or obstruction or for an infected struvite stone. On the other hand, no specific surgical therapy is required for asymptomatic stones, particularly those that are less than 5 mm in diameter.

Three minimally invasive surgical techniques that significantly reduce the morbidity of stone removal are available:

Percutaneous nephrolithotomy (PNL)

Rigid and flexible ureteroscopy (URS)

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Literature review current through: Nov 2017. | This topic last updated: Nov 25, 2016.
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