From sudden, severe pain to a stone that simply will not pass, there is a clear path forward. Dr. Sawkar offers the full range of modern, minimally invasive options, and most patients go home the same day.
Medically reviewed by Hari Sawkar, MD, board-certified urologist · Updated September 2026
A kidney stone is a hard deposit that forms in the kidney and causes trouble when it moves into the urinary tract. The pain can be intense and sudden. The good news is that nearly every stone can be treated, and many never need a procedure at all.
The best approach depends on the stone's size, location, and makeup. We will confirm which one fits and get you comfortable as quickly as possible.
Small stones, under about 5 mm, often pass on their own. With extra hydration and medication to ease the way, Dr. Sawkar monitors your progress so nothing is missed.
Focused shockwaves break the stone into fragments from outside the body, with no incisions, using sedation for comfort. The pieces then pass naturally over the days and weeks that follow.
A slim scope is passed through the urethra and bladder to reach the stone, where a Holmium laser breaks or vaporizes it. No incisions, and highly effective anywhere in the urinary tract.
Once the stone is handled, the goal is preventing the next one. A metabolic review and a simple, personalized plan can meaningfully lower your odds of forming another.
Size and location decide most of the plan. The millimeters on your CT report place you in one of these rows; pain, infection, and how well the kidney is draining decide how quickly we move, and they outrank the number.
| Stone size | If it is in the kidney | If it is in the ureter | Usual plan |
|---|---|---|---|
| Under 5 mm | Usually watched with periodic imaging | Passes on its own most of the time | Fluids, a strainer, tamsulosin to relax the ureter, follow-up imaging in two to four weeks |
| 5–10 mm | Watched if silent; treated if it grows or hurts | Passes about half the time; a trial of up to about four weeks if pain is controlled and there is no infection | Trial of passage first, ureteroscopy or shockwave if it stalls |
| 10–20 mm | Treated, usually shockwave or ureteroscopy depending on location and density | Rarely passes; treated | Ureteroscopy with laser for hard or lower-pole stones, shockwave for softer stones in the kidney or upper ureter |
| Over 20 mm or staghorn | Percutaneous nephrolithotomy (PCNL), a keyhole procedure through the back | Not applicable | PCNL, usually one night in the hospital |
| Any size with fever or a blocked single kidney | Emergency drainage with a stent or nephrostomy tube first, definitive treatment once the infection clears | Same | Same-day care |
Ranges from the AUA and EAU stone guidelines and published CT-based series. Pain, infection, and kidney function change the plan more than a millimeter does.
Same-day and next-day visits for acute stone pain are seen at the Tustin office at 18302 Irvine Blvd. If you already have a CT or ultrasound from an emergency room or urgent care, bring the disc or have the report sent; the images are reviewed at the visit rather than at a later appointment. The first job is bringing the pain under control. The second is a plan you leave with, whether that is a trial of passage with a strainer and tamsulosin or a date for a procedure.
Procedures are done as outpatient surgery at Providence St. Joseph Hospital in Orange, where Dr. Sawkar is Chief of Urology. If you have already been to an emergency room with a stone, or had a stent placed there to relieve a blockage, the office arranges definitive treatment and stent removal within days rather than weeks, so you are not living with a stent while you wait for a first appointment. Medicare and most PPO plans are accepted, and follow-up after the stone is cleared can be done by telehealth when that is easier.
For acute pain, we get you in quickly, confirm the stone with imaging, and bring the pain under control.
We choose the approach that fits your stone's size, location, and type, most of them outpatient.
A prevention plan to lower the chance of the next one, with follow-up whenever telehealth is easier.
Same-day or next-day for acute stone pain. Send the office a secure message or call; bring any imaging or emergency-room records, and the visit covers pain control, a review of the scan, and the plan.
Size and location decide. Stones under 5 mm pass most of the time, 5 to 10 mm stones pass about half the time, and stones over 10 mm rarely do. The kidney stone size chart on this site walks through the odds and timing.
Ureteroscopy clears more stones in one session and works on hard or lower-pole stones; shockwave avoids any scope and suits softer stones in the kidney or upper ureter. Stone density on CT, location, and your preferences decide.
Often, for a few days to about a week, to keep the ureter open while swelling settles. It is removed in the office, usually without another anesthetic. Not every case needs one.
Shockwave lithotripsy and ureteroscopy are outpatient; you go home the same day. Percutaneous nephrolithotomy for very large stones usually means one night in the hospital.
Enough fluid to make about 2.5 liters of urine a day, less sodium, normal dietary calcium rather than restriction, and citrate from lemons or medication when needed. A 24-hour urine collection after the first stone tailors the plan to your chemistry.
Same-day and next-day appointments for acute stone pain. Medicare and most PPO plans accepted, with telehealth consultations available. For the fastest response, send the office a secure message; the reply comes back by text.
Chief of Urology, Providence St. Joseph Hospital · UroLift Center of Excellence · Orange County's highest-volume Aquablation surgeon