“A doctor told me I have a kidney stone, but I don’t feel any pain. Do I still need treatment?”
A man in his early 50s visited the clinic after an incidental finding of a kidney stone during a routine health check-up. He had no noticeable symptoms, and at another hospital he was advised that the stone was small and could simply be monitored. However, concerned about potential risks, he sought a more precise evaluation.
Further examination revealed a kidney stone measuring approximately 1.2 cm. It was not only relatively large but had also increased in size compared to previous imaging and was located near the entrance of the ureter. Although the patient remained asymptomatic, leaving the condition untreated posed a significant risk. The stone could migrate into the ureter, causing severe pain, or lead to long-term damage to kidney function. In many cases, kidney stones remain silent while in the kidney but can cause intense pain, hematuria, infection, or impaired renal function once they obstruct the ureter.
Patients often ask, “If it doesn’t hurt, can I just leave it alone?” The answer depends on multiple factors. Not all kidney stones require immediate treatment. Management decisions are based not only on symptoms but also on the size, location, number, and progression of the stones. For example, stones smaller than 4 mm, located deep within the kidney, stable in size, and solitary may be monitored with periodic follow-up. However, in cases like this—where the stone is increasing in size, located in a position likely to cause obstruction, or associated with a higher risk of recurrence—treatment is recommended even in the absence of symptoms. Patients with a prior history of painful stone episodes or emergency visits should be particularly cautious, as recurrence is common.
After careful discussion, the patient chose to undergo endoscopic kidney stone removal. This procedure involves inserting a flexible ureteroscope through the urinary tract to access the kidney, where the stone is fragmented using a holmium laser and removed. The procedure is minimally invasive, requires no external incision, and allows for relatively quick recovery. While extracorporeal shock wave lithotripsy (ESWL) can be considered depending on stone size and density, in this case, the stone size made endoscopic treatment more appropriate. For larger or harder stones, percutaneous nephrolithotomy (PCNL) may be necessary, but in this situation, endoscopic management was sufficient.
The procedure was successful, with complete removal of all stones and no complications. The patient was discharged without issues. To reduce the risk of recurrence, additional metabolic evaluation was performed. Kidney stones have a high recurrence rate, and identifying underlying metabolic abnormalities is important for prevention. Depending on the results, abnormalities in calcium, oxalate, or uric acid levels may require targeted preventive treatment. In general, patients are advised to drink at least 2 liters of water daily, reduce salt intake, limit excessive protein consumption, and maintain consistent dietary management.
Kidney stones should not be dismissed simply because they are small or asymptomatic. At the same time, not all cases require immediate surgery. Effective management requires a personalized approach that considers stone size, location, number, and the patient’s medical history and risk factors. Once a kidney stone is detected, consultation with a urology specialist is essential to determine the appropriate course of action. Even in the absence of symptoms, untreated stones can lead to more serious complications over time.
If a kidney stone is discovered during a health screening or evaluation for another condition, it is important not to overlook it. A thorough assessment and professional consultation are necessary, as a seemingly silent stone may later result in significant pain or kidney damage.