Most people who have passed a kidney stone can tell you exactly where they were when the pain started. It arrives without warning, usually in the flank or the side of the back, and it does not settle when you change position — which is what separates it from a muscular backache. Patients describe it as the worst pain of their lives, and men who have had both often rank it above a fracture.
Across Panchkula, Chandigarh, Mohali and Ambala, stone disease is one of the most common reasons anyone ends up in a urologist's clinic. That is not an accident of local practice. It is geography.
Why North India is a "stone belt"
India sits on a broad band of high stone prevalence running through Rajasthan, Gujarat, Punjab, Haryana, Delhi and beyond. Population studies place stone disease at roughly 12% of Indians overall, with northern states reporting figures closer to 15% — appreciably higher than the south.
Four things drive that:
Heat and fluid loss. Tricity summers routinely push past 40°C. Sweat losses at that temperature are substantial, and very few people increase their water intake to match. Urine volume falls, dissolved minerals become concentrated, and crystals get the conditions they need to form. This is why urology clinics across India see a visible surge in stone presentations through May and June.
Chronically low water intake. Surveys of Indian stone patients repeatedly find the majority drinking under two litres a day. That is not enough anywhere; in a hot, dry climate it is well short.
Diet. High salt intake raises the amount of calcium the kidney excretes into urine. Heavy oxalate loads, low intake of citrus and fruit, and high animal protein all push in the same direction.
Family history. Stone disease clusters strongly in families across this region, and recurrence rates within a family are high. If a parent or sibling has formed stones, your own risk is meaningfully raised.
None of these is fixed. Three of the four are things you can change this week.
What kidney stones actually feel like
The textbook presentation — renal colic — is severe, wave-like pain that begins in the flank and radiates down towards the groin as the stone moves. It is usually accompanied by nausea or vomiting, and patients are restless, pacing, unable to find a comfortable position.
But stones present in quieter ways too:
- Blood in the urine, either visible or picked up only on a urine test
- Burning or frequent urination, often mistaken for a simple urinary infection
- A dull, persistent ache in the flank that comes and goes over weeks
- Nothing at all — a large proportion of kidney stones are found incidentally on an ultrasound done for something else
That last group matters. A stone sitting silently in the kidney is not automatically harmless. If it grows, or drops into the ureter and blocks it, it can damage the kidney quietly over months. Silent obstruction is one of the more common routes to avoidable kidney loss.
When a stone is an emergency
Most stone pain, however severe, can wait until morning. Some cannot. Go to a hospital immediately if you have fever or chills alongside flank pain, complete inability to pass urine, pain that does not respond to painkillers, or persistent vomiting preventing you keeping fluids down.
An infected, obstructed kidney is a true urological emergency. Bacteria trapped behind a blockage can seed the bloodstream within hours. This needs urgent drainage — a ureteric stent or a percutaneous nephrostomy — not just antibiotics, and not elective stone surgery.
The same urgency applies if you have a single functioning kidney with new obstruction, or blockage demonstrated on both sides. Everything else can be evaluated in a planned way.
How stones are diagnosed
Non-contrast CT of the kidneys, ureters and bladder (NCCT KUB) is the reference standard. It finds nearly every stone, gives an exact size and position, and measures stone density — which directly influences which treatment will work. Low-dose protocols keep radiation modest.
Ultrasound is useful as a first look, in pregnancy, and in follow-up, but it misses ureteric stones frequently and tends to overestimate size.
X-ray KUB helps track a known radio-opaque stone but should not be relied on for diagnosis.
Alongside imaging: a urine routine and culture, serum creatinine, calcium and uric acid. For recurrent stone formers, a fuller metabolic evaluation including a 24-hour urine collection is worth doing — it changes management in a substantial minority of patients.
Treatment: matching the method to the stone
There is no single best stone operation. The right choice depends on stone size, location, density, kidney anatomy, and the patient's own circumstances.
Watchful waiting and medical expulsive therapy
Small ureteric stones often pass on their own. Broadly, stones under 5 mm pass in a large majority of cases; between 5 and 10 mm the odds fall to roughly half; above 10 mm, spontaneous passage is unlikely.
For a suitable stone in the lower ureter, an alpha-blocker such as tamsulosin can improve passage rates and reduce pain episodes. This is a reasonable trial for a few weeks — with adequate pain control, and with a clear plan to intervene if the stone doesn't move or the kidney stays obstructed. Waiting indefinitely is not a strategy.
Shock wave lithotripsy (SWL/ESWL)
Focused shock waves fragment the stone from outside the body. It is non-invasive and requires no incision. Current international guidance advises against SWL as first-line treatment for lower-pole kidney stones larger than 1 cm, or non-lower-pole stones larger than 2 cm — clearance rates in those situations are poor. Dense stones and obese patients also do less well.
Ureteroscopy and RIRS
A fine telescope is passed through the natural urinary passage — no cut — up to the stone, which is fragmented with a laser and removed. Flexible ureteroscopy, or retrograde intrarenal surgery (RIRS), reaches stones inside the kidney itself.
Stone-free rates are higher than SWL, and it is the preferred approach in patients on blood thinners who cannot safely stop them. Most patients go home within a day. A temporary ureteric stent is often left in place for one to two weeks.
PCNL and mini-PCNL
For larger stone burdens, a small tract is made through the flank directly into the kidney and the stone is removed through it. Guidelines recommend percutaneous surgery as first-line treatment for total renal stone burden above 2 cm, and for large proximal ureteric stones, because clearance rates are consistently higher than the alternatives. Miniaturised instruments (mini-PCNL) extend this approach to stones up to around 3 cm with smaller tracts and less bleeding.
Open stone surgery is now needed only rarely.
The practical point: a 6 mm stone in the lower ureter and a 22 mm staghorn stone in the kidney are different diseases requiring different operations. Any advice you receive that skips straight to a procedure without a CT and a discussion of alternatives is worth questioning.
Preventing the next stone
This is where most stone care falls short. About half of people who form one stone form another within five to ten years. Prevention is not glamorous, but it works.
Drink enough to produce 2.5 litres of urine a day. Note the wording — urine output, not intake. In Tricity summers, and especially for anyone working outdoors, that usually means over three litres of fluid daily. A simple test: your urine should be pale straw-coloured, not deep yellow, for most of the day.
Cut the salt, not the calcium. Reducing sodium to under about 5 g of salt a day directly lowers urinary calcium. Meanwhile, restricting dietary calcium is actively counterproductive — a common and damaging misunderstanding. Calcium eaten with meals binds oxalate in the gut so it never reaches the kidney. Cutting dairy raises stone risk. Normal dietary calcium, taken with food, is what you want. (Calcium supplements taken between meals are a different matter and should be discussed.)
Add citrate. Citrate is the body's natural stone inhibitor. Lemon or lime juice in water is a genuinely useful, cheap intervention. Some patients benefit from prescribed potassium citrate.
Moderate oxalate, don't eliminate it. Spinach, beetroot, nuts, chocolate and strong tea are the main sources. For most people, moderation plus adequate calcium at the same meal is sufficient. Blanket elimination diets are rarely necessary and rarely sustained.
Ease back on animal protein. High intake of red meat and organ meat raises uric acid and urinary calcium while lowering citrate.
Find out what your stone was made of. If you pass a stone or have one removed, have it analysed. Calcium oxalate, uric acid, struvite and cystine stones need different prevention strategies. Uric acid stones, in particular, can sometimes be dissolved medically without any surgery at all — but only if you know that's what you have.
Frequently asked questions
Can kidney stones be dissolved with medicine?
Uric acid stones can often be dissolved by alkalinising the urine. Calcium-based stones — the large majority — cannot. Any product claiming to dissolve all stones is not being straight with you.
Does beer help pass stones?
No. The diuretic effect is real but trivial compared to the harm, and alcohol raises uric acid. Water is better in every respect.
Is stone surgery painful?
Modern endoscopic surgery is done under anaesthesia and most patients have limited pain afterwards. The commonest source of discomfort is the temporary stent, not the operation, and that discomfort ends when the stent is removed.
How long is recovery?
Most ureteroscopy and RIRS patients return to desk work within two to four days. PCNL usually needs about a week.
Will I definitely get another stone?
Not if prevention is taken seriously. Recurrence is common in untreated stone formers, but consistent fluid intake, sodium reduction and targeted treatment based on stone type substantially lower that risk.
Medically reviewed by Dr. Navdeep Garg, MCh (Urology), FEBU. This article is general information about urological conditions and does not constitute medical advice. Treatment decisions depend on individual assessment. For any medical concern, please consult a qualified physician.