Surgical removal of kidney stones

Policy No: SRP 116

Status: Group prior approval
Effective date: 1 April 2026
Next review date: 1 April 2028

Urinary tract stones are amongst the most common condition dealt with by urologists with an estimated 6,000 patients admitted to hospital per year with the condition. Shockwave lithotripsy (SWL) is a non-surgical technique for treating these stones in the kidney or ureter. The technique uses high energy shockwaves to break the stones into smaller fragments which can then pass spontaneously.

Stones can be observed to see if they pass spontaneously, or treated with shockwave lithotripsy, or surgical techniques such as ureteroscopy (URS) and percutaneous stone surgery (PCNL), both of which may involve placing a stent.

The optimal management depends on the type, size and location of the stone as well as patient factors such as co-morbidity and pregnancy.  For appropriate stones SWL is advantageous as it is non-invasive and so has fewer major adverse events than surgery.

Essex ICB commissions surgical removal of kidney stones on a restricted basis in-line with guidance from NICE NG118:

Adult renal stones

  • <5mm: If asymptomatic consider watchful waiting
  • 5-10mm: If not suitable for watchful waiting offer SWL as first-line treatment.

Consider URS instead of SWL:

  • if there are contraindications for SWL or
  • if a previous course of SWL has failed or
  • because of anatomical reasons, SWL is not indicated

Consider PCNL if SWL and URS have failed to treat the current stone, or they are not an option.

  • 10-20mm: Consider SWL or URS as first-line treatment.  Consider PCNL if URS or SWL have failed
  • Over 20mm (including staghorn): Offer percutaneous nephrolithotomy (PCNL) as first-line treatment.  Consider URS if PCNL is not an option e.g. due to patient fitness or anatomy.

Adult ureteric stones

  • <5mm: If asymptomatic consider watchful waiting with medical therapy e.g. alpha blocker for use with distal ureteric stones
  • 5-10mm: Consider SWL as first-line treatment where it can be accessed and given in a timely fashion (unless contra-indicated or not targetable).  URS can be offered as an alternative
  • 10-20mm: Offer URS but consider SWL if local facilities allow stone clearance within 4 weeks
Information:

Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.  The clinician undertaking the intervention is responsible for ensuring that documented evidence is recorded for audit purposes.

Individual funding requests should only be made where the patient demonstrates clinical exceptionality.

Further information on applying for funding in exceptional clinical circumstances can be found on the ICBs website.

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