Mr. Wang, who is in his 40s, started to feel some vague pain and discomfort in his left lumbar region about ten years ago, and was examined and found to have a small stone in his left kidney, which was not aggravated after he took some Chinese medicine and felt that it did not affect him much. In a recent physical examination, ultrasound found a thumb-sized stone in his left kidney, “strange! The stone is so big, but he doesn’t feel much, what should he do?” He muttered in his heart. Later, he underwent intravenous pyelogram and other tests, which reported that he had multiple stones in his left kidney, the largest of which was about 28 mm x 23 mm, with moderate hydronephrosis and reduced left kidney function. He was very anxious and asked around, some friends said he needed open surgery to remove the stone, some said it was feasible to remove the stone under minimally invasive microscope, and some said he could have extracorporeal shock wave lithotripsy, so he was lost. Once he came to me with his test report and I told him after reading the results carefully, “Minimally invasive surgery is possible to remove the stone.” He was puzzled: “How can I get such a big stone out?” I explained to him, “It is to pierce a channel the size of a drinking straw in the lumbar area toward the renal pelvis and remove the stone by breaking it up under the microscope, the operation will have less impact on the body.” After my patient explanation, he agreed to my treatment plan, and after various preoperative examinations and preparations, he underwent a minimally invasive percutaneous nephrolithotomy (PCNL) under anesthesia on the same day, and the operation went smoothly, and all the kidney stones were broken and flushed out and removed in one time. Kidney stone is a common disease, urinary stones mostly originate from kidney stones, according to statistics, about 5% of people have urinary stones at least once in their lifetime, the southern region of China is a high incidence of stone disease, so it is necessary to have some basic understanding of the diagnosis and treatment of urinary stones. Kidney stones can cause pain, hematuria, obstructive hydronephrosis and even renal hypofunction, but the symptoms are not necessarily proportional to the size of the stones. There are many factors affecting stone formation and the cycle of stone formation is long. Although uric acid and infectious stones can be prevented and treated by taking medication, most of them are clinically mixed stones and the mechanism of formation of its main component calcium oxalate stones is not well understood, so preventing stone formation is more complicated and difficult in most cases. How to treat and manage kidney stones is important for the prognosis of the disease. Here are some basic treatment options for kidney stones: 1. Generally speaking, kidney stones smaller than 6 mm may be expelled from the body through the ureter, but whether they can be expelled or not is related to the location of the stone, the structure of the kidney and the treatment method. If the location or size of small stones in the kidney does not change, it usually has little effect on the body and can be observed regularly and reviewed every six months to decide the treatment according to the development of the stones. Treatment by drinking more water, moderate activity and Chinese and Western medicine for stone removal may also be able to induce stone discharge. However, when the stone falls into the ureter, it can sometimes cause severe renal colic, which requires antispasmodic and analgesic treatment. 2. If the kidney stone is of medium size 6-20 mm, perhaps extracorporeal shock wave lithotripsy (ESWL) is the best choice, as smaller stones can often be discharged in one shot. Extracorporeal lithotripsy is less expensive than surgery and causes less pain to the patient, therefore, when the stones are less than 20 mm or the number of multiple small stones is small, treatment such as extracorporeal lithotripsy should be performed as early as possible, but of course, stones that are too small are not easily positioned by extracorporeal lithotripsy. When the stones are larger than 20 mm or multiple complex kidney stones, the treatment is sometimes more troublesome, mainly open surgery, extracorporeal shock wave lithotripsy and minimally invasive microscopic lithotripsy. Open surgery requires a long incision in the lumbar region and causes a lot of damage and pain to the patient, unless the kidney structure is special or the conditions are limited. Extracorporeal lithotripsy is often required to treat large stones several times, which not only causes damage to the kidney but also may form a stone obstruction in the ureteral cavity, which is not easily drained. At present, minimally invasive percutaneous nephrostomy and nephrolithotomy (MPCNL) is recommended, which involves puncturing the renal pelvis or calyces with a needle from the lumbar region under anesthesia, then expanding a channel of about 6 mm in diameter, placing a sheath, inserting a ureteroscope of only 3 mm in diameter through the sheath into the renal pelvis, and using a ballistic lithotripsy rod to break up the stones under the surveillance of the nephrolithoscope, and then flushing them out or removing them with water. The principle is somewhat similar to mining ore or cement blocks with a pneumatic drill. If the stone cannot be removed at one time, a combination of treatment such as phase II lithotripsy or additional extracorporeal lithotripsy is possible. With the progress of the times and the improvement of medical equipment, the treatment of kidney stones has changed a lot, and the treatment methods are different in each period and in each hospital. The specific treatment methods are based on various factors such as the size and location of the stone, hydronephrosis, kidney function and the condition of the patient. Mr. Wang found kidney stones ten years ago, if he could pay enough attention to regular checkups, when the stones are small, extracorporeal lithotripsy treatment may be easier to break the stones and discharge them, and he would not have to wait until the stones become so big and cause hydronephrosis and renal function damage before treatment, which not only cost more money and suffer more, but also cause hydronephrosis and renal function damage caused by stones are mostly irreversible, and may even cause kidney infection or Kidney failure. Although the stone is removed, the structure and function of the kidney are unlikely to return to the normal level. Therefore, kidney stones should be treated as early as possible and the appropriate treatment method should be chosen in order to achieve good results.