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Urology · London

Operations for kidney and ureteric stones,

Stone size, location and density decide the operation. ESWL for small favourable stones, ureteroscopy plus laser for most, PCNL for large or staghorn. We pick the surgeon and the technique that fit - and say when to wait instead.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private stone surgery costs in London.

Indicative ranges across UK private providers.

In short

£4,000–£8,000, home the same day.

Operation Indicative range
ESWL (shockwave lithotripsy) - see lithotripsy £2,000–£4,000
Ureteroscopy + laser lithotripsy (URS) £4,000–£8,000
PCNL (standard tract) £8,000–£14,000
Mini / micro / super-mini PCNL £8,000–£14,000
Emergency JJ stent for obstructed / infected stone £2,500–£4,500
JJ stent removal (flexible cystoscopy) £600–£1,200
Consultation only £200–£400

Prices vary by clinic, by the endourologist doing the case, by the operation and whether a stent, second look or metabolic workup is added.

The problem

The right operation for the stone in front of you.

Stone treatment goes wrong when the operation doesn’t fit the stone - ESWL on a dense lower-pole stone, or PCNL on a 6mm distal ureteric one. CT KUB and a clear plan fix this before it starts.

  • Small ureteric stone?

    Tamsulosin, fluids and pain relief for four weeks - most under 5mm pass on their own.

  • Renal stone up to 2cm?

    ESWL or ureteroscopy + laser. Density and location decide, not habit.

  • Big or staghorn stone?

    PCNL by an endourologist with volume - the operation that actually clears it.

When it helps

When an operation is the right step.

The situations we see most, plus the one red flag that means an emergency rather than an appointment.

  • Ureteric stone <10mm not passing

    Alpha-blocker (tamsulosin) plus fluids and pain relief - 60–80% of distal ureteric stones under 5mm pass within four weeks.

  • Renal or ureteric stone up to 2cm

    ESWL or ureteroscopy plus holmium/thulium laser - the standard for most stones in the upper tract today.

  • Renal stone >2cm or staghorn

    Percutaneous nephrolithotomy (PCNL). Direct access to the collecting system, fragmentation and extraction in one operation.

  • Lower-pole stone that ESWL missed

    Ureteroscopy with a flexible scope or a mini-PCNL - lower pole anatomy makes ESWL fragments hard to clear.

  • Recurrent stone-former

    Metabolic workup: 24h urine, PTH and electrolytes. Prevention with hydration, diet and, if needed, thiazide, allopurinol or potassium citrate.

  • Obstructing stone with sepsis

    A urological emergency. Decompression with a nephrostomy or JJ stent first - definitive stone treatment is delayed until infection clears.

  • Failed ESWL or dense stone

    Hounsfield density above 1,000 predicts poor ESWL - ureteroscopy plus laser or PCNL is usually the better first move.

  • Red flag: fever + flank pain + stone

    Pyonephrosis. Same-day A&E - antibiotics alone won’t work until the obstructed system is drained.

Operation options

One technique doesn’t fit every stone.

What each option involves - and which stone it fits. For the shockwave and laser detail, see the lithotripsy page.

  • Conservative - Medical Expulsive Therapy (MET)

    Tamsulosin 400mcg once daily, NSAID or opioid for pain, and hydration. Best for distal ureteric stones under 5–10mm; watch-and-wait for four weeks.

  • ESWL - extracorporeal shockwave lithotripsy

    Non-invasive shockwaves under sedation, for stones under 2cm in the upper ureter or renal pelvis. Detail on the dedicated lithotripsy page.

  • URS + laser lithotripsy

    A semi-rigid or flexible ureteroscope with Ho:YAG or thulium fibre laser. Dust or basket the fragments; JJ stent for 1–2 weeks. Workhorse for most stones now.

  • Standard PCNL (26–30Fr)

    Percutaneous access into the collecting system, tract dilated to 26–30Fr, nephroscope in, fragmentation with ultrasonic, ballistic or laser. For stones >2cm and staghorn calculi.

  • Mini / micro / super-mini PCNL

    Smaller tracts (11–22Fr) - less bleeding and shorter stay, at the cost of longer operating time. Increasingly used for 1–3cm stones.

  • Emergency decompression

    Nephrostomy or JJ stent for the obstructed infected kidney - done first, stone treatment second. See the nephrostomy page for the tract detail.

  • Open / laparoscopic stone surgery

    Rare today. Reserved for complete staghorn with distorted anatomy or when reconstruction (e.g. pyeloplasty) is being done at the same time.

  • Robot-assisted laparoscopic

    Emerging for complex stones combined with reconstructive surgery - a small share of cases in specialist centres.

Safety and recovery

What to expect afterwards - honestly.

Modern stone surgery is safe and effective, but each technique has its own pattern of complications. The things worth planning are infection control, stent life, and the prevention that stops the next one.

  • Infection is treated first

    A positive urine culture is dealt with before any stone operation. Operating on an infected obstructed kidney risks urosepsis - the single most dangerous complication.

  • ESWL - bruising and steinstrasse

    A perirenal haematoma is rare. The commoner nuisance is fragments queuing in the ureter (steinstrasse) - sometimes needing a stent and a further procedure.

  • URS - stent discomfort is common

    A JJ stent for 1–2 weeks is normal after ureteroscopy. Frequency, urgency and mild flank ache with urination are expected; the stent must not be forgotten.

  • PCNL - bleeding is the main concern

    Transfusion is needed in 1–3% and a small number need selective embolisation. Upper-pole access carries a rare risk of pleural injury.

  • Infection risk across all techniques

    Post-operative sepsis is 5–15% for PCNL and lower for URS/ESWL. Peri-operative antibiotics guided by culture reduce the risk.

  • Residual stones may need a second look

    ESWL clears 60–80% in one session, URS >90%, PCNL 80–90%. If fragments remain, a repeat or a look-again procedure is planned.

  • Ureteric stricture is rare but long-term

    Instrumentation of the ureter can very occasionally cause a late narrowing. Follow-up imaging picks it up early.

  • Prevention halves recurrence

    Recurrence is 30–50% at five years without prevention. Hydration >2.5L/day, dietary changes by stone type, and targeted drugs cut it significantly.

  • Red flags

    Fever, rigors, worsening flank pain, heavy bleeding or an inability to pass urine after any stone operation - same-day A&E, not next week’s clinic.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever technique was used, the note the endourologist sends you keeps to the same shape.

A UK consultant endourologist reviewing a patient’s operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your review, just ask.

  1. 01 Header

    Stone size, location and density

    Where the stone was, how big, and its Hounsfield density on CT KUB - the numbers that decided the operation.

  2. 02 Technique

    ESWL, URS or PCNL - what was done

    The operation performed, energy device used (shockwave, holmium/thulium laser, ultrasonic), tract size for PCNL, and any stent or drain left in.

  3. 03 Findings

    Stone-free status and complications

    Whether the kidney and ureter are stone-free at the end, any residual fragments, and any intra-operative issues (bleeding, perforation).

  4. 04 Impression

    Stent removal, follow-up, prevention

    Read this first: when the stent comes out, the imaging follow-up, and the metabolic workup plan for stone prevention.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for stone surgery is usually straightforward when medically indicated.

Frequently asked

Everything we get asked about stone operations.

Quick answers on which operation to have, cost, stents, recovery and how to stop the next stone.

  • Which stone operation will I need - ESWL, URS or PCNL?

    Stone size, location and density decide. Ureteric stones under 5mm often pass on tamsulosin. Stones under 2cm in the upper tract go to ESWL or URS + laser. Stones over 2cm and staghorn calculi go to PCNL. Density above 1,000 Hounsfield units on CT KUB predicts poor ESWL - URS or PCNL is usually better.

  • How much do private kidney stone operations cost in London?

    Roughly £2,000–£4,000 for ESWL, £4,000–£8,000 for ureteroscopy + laser, and £8,000–£14,000 for PCNL. A JJ stent removal is £600–£1,200.

  • Will I need a JJ stent, and how long does it stay in?

    After ureteroscopy, almost always - usually for 1–2 weeks. After ESWL only if there is a steinstrasse. After PCNL a JJ stent or nephrostomy drain sits for a few days to weeks. Removal is a quick flexible cystoscopy under local anaesthetic.

  • How long is recovery from each operation?

    ESWL: back to work in 1–2 days. URS + laser: 3–5 days off, longer if the stent is uncomfortable. PCNL: 2–4 weeks off work, 3–5 nights in hospital, no heavy lifting for six weeks.

  • What are the main risks of PCNL?

    Bleeding is the main concern - 1–3% need a transfusion and a small number need selective embolisation. Infection or sepsis in 5–15%. Rarely pleural or colon injury with upper-pole access. Residual stones may need a second look.

  • What is a pyonephrosis and why is it urgent?

    An obstructed kidney with infection above the block. Antibiotics can’t reach the pus behind the stone. Drainage with a nephrostomy or JJ stent must happen first - sometimes within hours - and the stone is dealt with after.

  • How likely is another stone in future?

    Roughly 30–50% within five years without prevention. Metabolic workup - 24h urine, parathyroid hormone, serum electrolytes - plus hydration over 2.5L/day, dietary changes and, if indicated, thiazide, allopurinol or potassium citrate cut recurrence significantly.

  • When should I see a GP or A&E urgently?

    Fever with flank pain and a known stone, rigors, uncontrolled pain, vomiting that stops fluids, blood in the urine with clots, or an inability to pass urine after any stone operation are all reasons to seek same-day medical help.

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