The incidence of kidney stones is very common in China, accounting for the first place among urology inpatients, and more than half of the emergency urology patients are patients like Mr. Zhang. The danger of kidney stones is not only to make the pain unbearable, but more serious is that if the stones exist for a long time and block the urinary tract, it may induce infection and kidney function damage. If the kidney function of both sides of the kidney stone is impaired or the kidney function of the sole kidney stone is impaired, the symptoms of uremia may appear. So, what are the precautions for kidney stone patients? How should we prevent the occurrence of kidney stones in daily life? If we know we have kidney stones, how should we treat them? Why some kidney stones are not painful? Is it good to have kidney stones without pain? Pain is the main symptom of kidney stones and its degree depends on the size of the stone, the presence or absence of obstruction and secondary infection. Stones that are inactive in the renal pelvis, without infection, can be asymptomatic for a long time, and even remain asymptomatic when they cause chronic renal insufficiency. Smaller stones have a large range of activity. When small stones enter the ureteral junction of the renal pelvis or ureter, they cause violent peristalsis of the ureter to induce stone discharge, and colic occurs. However, as the obstruction lengthens, the ureter expands due to water retention, and the pain is gradually relieved. Kidney stones are not painful, so the patient may think that the stones are well and delay the best time to seek medical attention. There are many patients in the clinic who have kidneys completely damaged due to stone obstruction, and these patients usually get worse because of the misconception that the kidney stones are painless. Therefore, if kidney stones are confirmed to have occurred, it is important to have regular follow-up examinations and treatment to ensure that no stone complications occur. How to diagnose kidney stones? The diagnosis of kidney stones can be confirmed in most cases by medical history, physical examination, ultrasound, X-ray, laboratory tests and, if necessary, CT examinations; ultrasound and X-ray urological plain films are the most commonly used tests for the diagnosis of kidney stones; more than 90% of kidney stones will show up on X-ray plain films, and the depth of shadowing is related to the chemical composition, size and thickness of the stones. Ultrasound is useful for the diagnosis of fluid and stones, especially for asymptomatic stones and uric acid stones that do not show up on X-ray. What are the methods to treat kidney stones? How to choose? Kidney stones are complex and variable, and the nature, form, size and location of the stones vary, whether there are adhesions between the stones and the surrounding area, whether there is obstruction at the distal end, whether there is fluid in the renal pelvis and calyces, and the patient’s general condition are all factors that need to be considered. Therefore, the choice of stone treatment method depends on the individual. Generally speaking, stones smaller than 0.6 cm in diameter can be treated by taking lithotriptic drugs and drinking a lot of water to dislodge small stones, or by taking drugs, adjusting the diet, increasing water intake, and alkalizing the urine to dissolve the stones and make them disappear. For stones larger than 0.6 cm and smaller than 2.0 cm in diameter or where medication is not effective, extracorporeal shock wave lithotripsy can be used. Extracorporeal shock wave lithotripsy is safe and effective, the procedure takes about 30 minutes, is less painful, has fewer side effects, generally does not require hospitalization, and does not affect work and life. If the stone size is larger than 2.0 cm, it is better to use surgical treatment, including open surgery and minimally invasive surgery, of which the latter is the mainstream of contemporary kidney stone treatment. What is minimally invasive kidney stone surgery? What are the benefits? Minimally invasive surgery for kidney stones generally refers to minimally invasive percutaneous nephrolithotomy (MPCNL), which is an advanced technique for treating kidney stones and upper ureteral stones, commonly known as “hole-punching surgery”. The ureteroscope, which is only 3 mm in diameter, is inserted and a pneumatic ballast or laser lithotripter is used to break up the stone and allow it to flow out along the channel. Compared with traditional open surgery, MPCNL has the advantages of less trauma, less pain, faster recovery and lower stone recurrence rate; compared with extracorporeal shock wave lithotripsy, it has the advantages of less loss of kidney function and higher stone removal rate. Patients can get out of bed on the second day after surgery and can be discharged on the third day. This technology has been widely carried out in tertiary hospitals across China, with Guangzhou, Beijing, Shanghai and other large and medium-sized cities being the most mature. Who are not suitable for minimally invasive surgery for kidney stones? Minimally invasive surgery is not suitable for patients with the following conditions: severe heart disease or pulmonary insufficiency that cannot tolerate surgery; uncorrected systemic bleeding disorders; uncontrolled diabetes mellitus or hypertension; those taking anticoagulant drugs such as aspirin and favalin, which need to be stopped for 2 weeks and rechecked for normal coagulation function before surgery can be performed. Are kidney stones easy to recur? It is certain that kidney stones are prone to recurrence. According to statistics, the annual recurrence rate of urinary stones is about 7%, and 50% of patients will have recurrence of stones within 10 years. The recurrence of stones is related to the composition and number of stones, whether the treatment is complete, the patient’s lifestyle and whether the patient suffers from the original disease that caused the stones to be formed. Some patients have residual stones left after extracorporeal shock wave lithotripsy, which also increases the chance of kidney stone recurrence. The high recurrence rate of kidney stones requires patients to visit the clinic regularly for routine checkups.