How to cite: Woo J. Managing Kidney Stone-Related Pain. Grand Rounds in Urology. March 2026. Accessed Oct 2026. https://grandroundsinurology.com/managing-kidney-stone-related-pain/
Summary
Jason Woo, MD, Associate Professor of Urology, University of California, San Diego, San Diego, California, reviews the management of kidney stone-related pain, emphasizing that pain is primarily caused by ureteral obstruction rather than the stone itself. As a stone migrates from the kidney into the ureter, it increases intraluminal pressure, induces smooth muscle spasm, and triggers inflammation, resulting in severe, colicky pain that may radiate from the flank to the groin. Associated symptoms include nausea, vomiting, and hematuria.
Dr. Woo outlines a multimodal approach to pain management. Nonsteroidal anti-inflammatory drugs and acetaminophen serve as first-line therapy and are the most effective agents for reducing pain. Opioids are reserved for breakthrough symptoms. Alpha blockers such as tamsulosin are routinely used to facilitate stone passage and may also reduce stent-related discomfort.
Dr. Woo highlights a common clinical scenario in which patients return after ureteral stent placement with persistent but altered pain. Stent-related symptoms include urinary urgency, frequency, dysuria, and flank pain due to bladder irritation and reflux of urine into the kidney during voiding. Adjunctive therapies, including anticholinergic agents and phenazopyridine, can help manage these symptoms.
Dr. Woo also discusses enhanced recovery after surgery protocols, which emphasize minimizing opioid use through preoperative, intraoperative, and postoperative multimodal analgesia strategies.
Dr. Woo stresses that effective management of kidney stone-related pain relies on consistent, scheduled use of non-opioid medications, adjunctive therapies tailored to symptom type, and patient education to maintain steady analgesic coverage rather than reactive dosing.
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
Jason Woo, MD, is an Associate Professor of Urology at the University of California, San Diego. Dr. Woo also serves as the Clinical Medical Director of Urology at the University of California Health Center in Hillcrest. He specializes in a wide range of male and female urologic problems, including stones in the urinary tract, erectile dysfunction, benign prostatic hyperplasia (BPH), voiding dysfunction, and urologic cancers.
