Written by Shirin

Published On : April 22, 2026 | Last Updated On : April 22, 2026

April 22, 2026

Ureteroscopy vs. PCNL: Choosing the Right Treatment for Stubborn Kidney Stones

When a kidney stone becomes too large or “stubborn” to pass naturally, patients are often faced with a choice between two primary minimally invasive procedures: Ureteroscopy (URS) and Percutaneous Nephrolithotomy (PCNL). While both are highly effective, the decision depends on the size, location, and complexity of the stone.

At Miami Robotic Surgery, Dr. Shirin Razdan utilizes her specialized training in endourology to help patients navigate these options, ensuring a “stone-free” outcome with the least invasive path possible.

Ureteroscopy (URS): The No-Incision Approach

Ureteroscopy is typically the preferred treatment for small to medium-sized stones (usually under 2 cm), especially those located in the ureter or the lower portions of the kidney.

How it Works: Dr. Razdan passes a thin, flexible telescope (ureteroscope) through the natural urinary tract—requiring zero incisions. Once the stone is located, a surgical laser fragments it into “dust” or small pieces that are then removed using a tiny basket.
The Recovery: Because there are no incisions, most patients go home the same day. Recovery is rapid, with most individuals returning to work within 24 to 48 hours.
Best For: Patients with smaller stones or those who wish to avoid even minor surgical incisions.

Percutaneous Nephrolithotomy (PCNL): The Gold Standard for Large Stones

When a stone is larger than 2 cm, irregularly shaped (like a staghorn calculus), or particularly dense, Ureteroscopy may require multiple sessions to achieve full clearance. In these cases, PCNL is the superior solution.

How it Works: Dr. Razdan creates a small, pencil-sized tract through the back directly into the kidney. This allows for the use of larger instruments that can break and physically remove massive stone burdens in a single setting.
The Recovery: PCNL generally requires an overnight hospital stay (1–2 days). While it involves a small incision (about 1 cm), the success rate for complete stone clearance in large cases is significantly higher than other methods, often reaching 90% or more.
Best For: Patients with “stubborn” stones that have failed previous treatments, or very large stones that require definitive, one-time removal.

Why Dr. Shirin Razdan is the Leading Choice in Miami

Choosing between URS and PCNL isn’t just about the stone—it’s about the surgeon’s ability to execute the plan with precision. As a 2025 Urology Research All-Star, Dr. Shirin Razdan brings elite technical expertise from the Icahn School of Medicine at Mount Sinai.

She is one of the few specialists in South Florida capable of performing “Ultra-Mini” PCNL and tubeless techniques, which bridge the gap between these two procedures—offering the stone-clearing power of PCNL with a recovery profile closer to Ureteroscopy.

Frequently Asked Questions

Will I have a stent after these procedures?

In many cases, a temporary stent is placed to ensure the kidney drains properly during the initial healing phase. Dr. Razdan typically removes these in the office a few days later with minimal discomfort.

Can robotic surgery be used for kidney stones?

While URS and PCNL are the standards, robotic surgery is an excellent option for stones caused by structural issues, such as a UPJ obstruction. Dr. Razdan specializes in correcting these underlying problems while simultaneously removing the stones.

Which procedure has a lower risk of recurrence?

The procedure itself removes the current stone, but recurrence depends on metabolic factors. Dr. Razdan provides a comprehensive post-op metabolic workup to identify why you are forming stones and how to prevent them permanently.

Get the Right Treatment the First Time

Don’t let a stubborn kidney stone lead to multiple failed surgeries. Consult with a specialist who masters the full spectrum of stone-clearing technology.

Contact Dr. Shirin Razdan: