How to cite: Sur RL. Kidney Stone Surgical Options: Shockwave, Scope, or Surveillance? Grand Rounds in Urology. March 2026. Accessed Oct 2026. https://grandroundsinurology.com/kidney-stone-surgical-options-shockwave-scope-or-surveillance/
Summary
Roger L. Sur, MD, Professor, Department of Urology, University of California, San Diego, San Diego, California, reviews surgical and non-surgical management options for kidney stones, emphasizing that treatment selection depends on stone size, location, patient factors, and clinical presentation.
Dr. Sur outlines the role of imaging in evaluation, noting that unenhanced computed tomography is the preferred modality for surgical planning due to its ability to define stone size, location, density, and anatomy. Ultrasonography and plain radiography remain useful in select contexts but have limitations in sensitivity and specificity.
He emphasizes that certain clinical scenarios require urgent intervention, particularly in cases of infected stones. Patients presenting with fever or signs of systemic infection should be referred immediately for drainage, as delay can lead to rapid clinical deterioration.
For stable patients, management options include observation, medical expulsive therapy, and surgical intervention. Medical expulsive therapy with alpha blockers is appropriate for small distal ureteral stones in patients with controlled symptoms and normal renal function.
Dr. Sur reviews three primary procedural approaches. Shockwave lithotripsy is non-invasive and best suited for smaller stones less than one cm, though success rates vary by stone location. Ureteroscopy is a highly effective and commonly used approach for stones less than two cm, allowing direct visualization and removal, though it typically requires temporary stent placement. Percutaneous nephrolithotomy is the preferred option for large or complex stones, including staghorn calculi, offering high stone-free rates at the cost of increased procedural risk.
He also discusses management of asymptomatic stones, noting that observation is appropriate for many patients, though intervention may be considered based on occupational risk, access to care, recurrent infection, or patient anxiety.
Dr. Sur emphasizes that kidney stone management requires individualized decision-making, balancing efficacy, invasiveness, and patient preferences.
About the UCSD Urology Symposium for Primary Care Physicians & Advanced Practice Providers
The UCSD (University of California San Diego) Urology Symposium for Primary Care Physicians & Advanced Practice Providers conference brings together primary care physicians, advanced practice providers, and early-career urology clinicians who play pivotal roles in the urologic care continuum. It features topics such as benign prostatic hyperplasia, overactive bladder, kidney stones, sexual health, and urologic oncology. Through didactic lectures and interactive sessions that highlight the patient journey, the conference educates practitioners on guiding patients and their families toward the most appropriate therapies.
ABOUT THE AUTHOR
Roger L. Sur, MD, is the Founder and Director of the Comprehensive Kidney Stone Center, a Professor in the Department of Urology, and the Director of the joint UC San Diego-Kaiser Endourology Fellowship at the University of California, San Diego. Dr. Sur also holds positions as a Urologist at the VA San Diego Healthcare System and as an Associate Professor of Surgery at the Uniformed Services University. He specializes in percutaneous nephrolithotomy using the latest, minimally invasive techniques.
