Once you find out you have kidney stones or ureteral stones, the question of whether and when to start treatment is one of the first questions patients face. First of all, kidney colic caused by ureteral stones and kidney infection or even systemic infection caused by stone obstruction must be treated according to the principle of emergency treatment, while other cases can be treated according to the following principles. The timing of treatment for kidney stones: It is still controversial whether asymptomatic kidney stones without hydronephrosis require immediate active treatment. One study showed that 77% of patients with asymptomatic kidney stones develop disease progression during follow-up, and 26% of patients require surgical intervention. The 2013 edition of the European Society of Urology Guidelines for the Diagnosis and Treatment of Urinary Stones introduced the concept of active removal of kidney stones, which includes the following conditions: stone growth, risk factors for stone formation, stones causing urinary obstruction, infection, symptoms such as pain and hematuria, stones >1.5 cm in diameter, or stones <1.5 cm in diameter. , or patients with stones <1.5 cm in length but not suitable for observation, the patient's own predilection, the presence of comorbidities such as diabetes and cardiovascular disease, the patient's occupational requirements or the need for prolonged travel. In other words, surgical intervention to remove kidney stones may be an option as soon as possible in the presence of these conditions. Kidney stones that are excluded from the above mentioned conditions can be selected for regular observation. During the observation period, you can combine with medications to remove the stones. Western medications mainly include calcium antagonists (e.g. cardiac pain) and α1 receptor antagonists (e.g. tamsulosin, trade name Harle), whose mechanism of action is to relax the smooth muscle of the ureter to facilitate the discharge of stones; there are many Chinese herbal medicines, including various formulas, and single herbs such as moneywort, whose mechanism of action is mainly diuretic and laxative. Annual follow-up with ultrasound, intravenous pyelogram or CT is mandatory. Risk factors for kidney stone formation include the following: kidney stones during childhood, family history of kidney stones, stones containing calcium hydrogen phosphate, uric acid stones, infectious stones, inflammatory bowel disease, history of intestinal resection or bypass surgery, hyperparathyroidism or renal tubular acidosis diseases, and anatomical malformations of the urinary tract. Patients with kidney stones who are at high risk for stone formation should be closely followed up and treated aggressively. The concept of active removal of ureteral stones is also proposed in the 2013 edition of the European Society of Urology Guidelines for the Diagnosis and Treatment of Urolithiasis, which includes the following conditions: low probability of self-expulsion of stones, persistent unrelieved renal colic after analgesic medication, hydronephrosis, and the development of renal colic. The main conditions are: a low probability of self-expulsion of stones, persistence of renal colic without relief after treatment with analgesic drugs, hydronephrosis, impairment of renal function (renal failure, bilateral ureteral stones leading to obstruction and isolated kidney). In these cases, surgical intervention to remove ureteral stones is required as soon as possible. In the absence of these conditions, it is possible to wait for observation. Because ureteral stones of different sites and sizes have the potential to pass out of the body on their own, once a ureteral stone is found and the conditions for active stone removal do not exist, observation waiting is generally preferred. During the observation period, pharmacological lithotripsy can be used. Studies have shown that for ureteral stones ≤5 mm in size, there is about a 68% chance of self-discharge; for ureteral stones between 5 mm and 10 mm in size, there is about a 47% chance of self-discharge. For ureteral stones ≤6 mm in size, it takes about 40 days to pass out of the body by itself. Of course, the ability of ureteral stones to pass on their own is also related to the narrowing of the ureteral lumen and the shape of the stones.