Kidney stones service

The Royal Free London kidney stone service is run by a team of consultant urological surgeons with extensive training in general urology and a significant sub-specialty interest and experience in the diagnosis and treatment of stones. We are one of the only NHS trusts in the country who offer an integrated, multidisciplinary approach in conjunction with our nephrology colleagues. Not only do we offer prompt, effective treatment of stones using state of the art minimal access techniques, our nephrologist supporting the service will assess and treat the cause of stone formation, thereby reducing the risk of subsequent attacks of renal colic. Our nephrologists offer case specific lifestyle and dietary advice to be given as well as occasionally pharmacological treatment to try and prevent stone recurrence. We have weekly multidisciplinary meetings where complex stone cases are discussed.

Once stones have formed we offer a rapid access to state of the art treatments to help remove the stone(s). Details on these treatments can be found below:

Extra corporeal shockwave lithotripsy (ESWL)

Extra corporeal shockwave lithotripsy (ESWL) is a non-invasive treatment for stone disease. Our patients are offered prompt access to this treatment, which is performed as an out-patient service. Each treatment session takes one hour on average. There are usually very few side effects associated with this treatment and you will be able to return to your normal life very quickly. Three sessions are often required to see if the stones will break up effectively. Stones may be too large, too hard or in an inappropriate position for it to be effective. Blood thinning tablets, pacemakers and obesity often preclude the treatment.


Ureteroscopy is a minimally invasive procedure, usually performed as a day case under a general anaesthetic. This involves the passage of a fine ureteroscope into the ureter and, occasionally, into the kidney to locate the stone. The stone is vapourised with the aid of a holmium laser. Patients are admitted on the morning of surgery but will need to attend pre-assessment prior to this to make sure they are medically fit. Often a stent is left in after the procedure to avoid narrowing of the ureter. The stent will later be removed, either with a flexible cystoscope under a local anaesthetic or as part of a re-look ureteroscopy under a general anaesthetic.

Percutaneous nephrolithtomy (PCNL)

A percutaneous nephrolithtomy (PCNL) is keyhole surgery (your surgeon will make a one inch incision) directly into the kidney and requires a general anaesthetic as well as an in-patient stay of approximately two days. The Royal Free London is one of the few units in the country with excellent experience in performing this procedure with patient in a supine lithothomy position allowing for safer anaesthetic and maximum comfort for the patient, as well as excellent results. We are internationally renowned for our supine PCNL technique, running national and international courses educating our consultant colleagues across the profession.

We are also fortunate to have a dedicated team of highly skilled interventional radiologists who help us access the correct part of the kidney containing the stone during the operation. Our radiologists also offer a 24 hour emergency support service.