How Doctors Remove Kidney Stones Without Open Surgery

Kidney stones can be extremely painful, but modern medicine has made it possible to treat many stones without the large incisions associated with traditional open surgery. Depending on the stone’s size, location, composition and the patient’s condition, urologists can use shock waves, tiny endoscopic instruments or minimally invasive access to break or remove the stone.

The important point is that “without open surgery” does not mean every procedure is completely incision-free. Some techniques enter the urinary tract through its natural passages, while others use only a very small access point through the skin. The choice depends on the individual stone and the patient rather than on a single universal treatment.

Why kidney stones sometimes need to be removed

Small stones can sometimes leave the body naturally through the urinary tract. Doctors may monitor these stones and manage symptoms while waiting for them to pass.

The situation changes when a stone becomes too large to pass, blocks urine flow, causes persistent severe pain, grows, or is associated with infection. In these circumstances, active stone removal may be necessary. The 2026 European Association of Urology guidelines list obstruction, infection, symptoms such as pain or blood in the urine, stone growth and certain patient-specific factors among reasons to consider active removal.

A particularly serious situation occurs when an obstructed urinary system is accompanied by infection or an inability to produce urine. The EAU considers this a urological emergency because the urinary tract may need urgent decompression before definitive stone treatment.

The first technique: breaking the stone from outside the body

One of the most remarkable approaches is shock wave lithotripsy, commonly called SWL or ESWL.

Instead of inserting an instrument into the urinary tract, a specialized machine generates focused shock waves outside the body. These waves are directed toward the stone and cause it to fracture into smaller pieces.

The fragments can then pass through the urinary tract naturally.

This is why the technique is often described as a non-invasive method of stone treatment. The National Institute of Diabetes and Digestive and Kidney Diseases explains that shock wave lithotripsy can break kidney stones into smaller pieces so they can pass more easily through the urinary tract.

However, SWL does not work equally well for every stone. Stone size, location and composition can affect the outcome, as can the patient’s body characteristics and how accurately the stone can be targeted. The 2026 EAU guidelines specifically emphasize imaging, correct positioning and effective transmission of the shock waves during treatment.

In some cases, more than one treatment session may be required.

When doctors use a tiny camera instead

Another major technique is ureteroscopy.

Here, the doctor does not need to make a large incision through the abdomen. Instead, a thin instrument called a ureteroscope is guided through the body’s natural urinary passage.

The instrument travels through the urethra and bladder and then into the ureter or kidney. A camera at the end allows the urologist to see the stone directly.

Once the stone is located, the doctor can remove it with specialized instruments or break it into smaller pieces.

Modern laser technology has made this procedure particularly precise. The 2026 EAU guidelines recommend holmium:YAG or thulium fiber laser lithotripsy for flexible ureteroscopy. The laser can fragment the stone into pieces that can subsequently be extracted or allowed to pass.

This approach is especially interesting because the surgeon can actually see the stone while treating it, rather than relying solely on external shock waves.

What happens to the stone after the laser breaks it?

Laser treatment can be used in different ways.

A larger stone can be fragmented into several pieces, while a technique sometimes described as “dusting” breaks the stone into very small particles.

Other fragments may be captured using a tiny basket inserted through the ureteroscope.

The choice depends on factors such as the stone’s size, location, composition and the equipment available.

The EAU guidelines note that stone fragments can be extracted using baskets or other endoscopic techniques, while modern laser systems provide effective intracorporeal lithotripsy during flexible ureteroscopy.

What is the small tube doctors sometimes leave behind?

Patients undergoing ureteroscopy may sometimes have a ureteral stent placed temporarily.

A stent is a thin flexible tube that helps maintain urine flow between the kidney and bladder while the urinary tract recovers or while remaining fragments pass.

Importantly, a stent is not automatically required after every uncomplicated ureteroscopy. The 2026 EAU guidelines recommend avoiding routine stent placement in uncomplicated cases, although stents may be appropriate in specific circumstances.

Patients can sometimes experience urinary discomfort, urgency or other symptoms while a stent is in place, which is why doctors decide whether it is necessary based on the circumstances of the procedure.

What about very large kidney stones?

For large or complex kidney stones, doctors may use another minimally invasive procedure called percutaneous nephrolithotomy, or PCNL.

This procedure is different from ureteroscopy because the surgeon creates a small access channel directly through the skin into the kidney.

A nephroscope is passed through this access point, allowing the surgeon to locate and remove the stone. Large stones can also be fragmented with energy devices or lasers before removal.

So, technically, PCNL is not incision-free. But the access is much smaller and more targeted than traditional open surgery.

The EAU describes PCNL as the standard procedure for large renal calculi, particularly when stone size or complexity makes other approaches less suitable.

Why doctors don’t simply use the same treatment for everyone

Kidney stones are not identical.

A treatment that works well for one patient may not be the best option for another. Doctors consider several variables before deciding how to remove a stone.

These include:

The stone’s size
Its location in the urinary system
Its chemical composition
Whether it is obstructing urine
Whether infection is present
The patient’s anatomy
Previous stone treatments
Other medical conditions
The likelihood of achieving complete stone clearance

For example, the EAU notes that the effectiveness of shock wave lithotripsy depends substantially on stone size, location and composition. For larger renal stones, PCNL or other endoscopic approaches may provide better treatment options depending on the circumstances.

Open surgery has become much less common

The development of SWL, ureteroscopy and percutaneous procedures has dramatically changed the way kidney stones are treated.

According to the EAU’s current guidelines, advances in shock wave treatment and endourological procedures have significantly reduced the need for open or laparoscopic stone surgery. Open surgery is now generally reserved for unusual situations in which less invasive approaches have failed or are unlikely to succeed.

That represents a major shift in urology.

Instead of making a large incision to reach the kidney, doctors can often target the stone using focused energy, miniature cameras, laser systems and specialized instruments.

The technology behind modern stone removal

The science is essentially about finding the safest route to the stone while minimizing damage to surrounding tissue.

Shock wave lithotripsy uses externally generated mechanical energy.

Ureteroscopy uses miniature optical systems to provide a direct view inside the urinary tract.

Laser lithotripsy converts precisely controlled laser energy into stone-fragmenting action.

Percutaneous nephrolithotomy creates a small controlled pathway to the kidney so large stones can be removed directly.

Together, these technologies have transformed kidney stone management from a procedure that often required major surgery into one that can frequently be performed through natural openings or very small access points.

What happens after the stone is removed?

Removing the immediate stone is only part of the process.

Doctors may analyze the stone or its fragments to determine what it is made of. In some patients, a 24-hour urine collection can also be used to evaluate urine volume and mineral levels associated with stone formation.

This information can help doctors understand why the stone developed and determine strategies to reduce the chance of another one forming.

That is important because successfully removing one kidney stone does not necessarily prevent future stones.

A small stone can require surprisingly sophisticated technology

The modern treatment of kidney stones is a good example of how medical technology has changed over time.

What may look like a simple mineral fragment can require imaging, specialized instruments, laser systems, shock-wave technology and highly precise endoscopic procedures to remove safely.

And in many cases, doctors can accomplish this without the large abdominal incision associated with traditional open surgery.

The exact treatment, however, should always be determined by a qualified urologist after evaluating the patient’s stone and overall condition. Severe pain accompanied by fever, chills, vomiting, difficulty passing urine or other concerning symptoms requires prompt medical assessment because an obstructed and infected urinary system can be an emergency.