1. Conservative Management (Watchful Waiting + Medical Expulsive Therapy) Small stones under 5–6mm in the ureter have a good chance of passing spontaneously. Medical expulsive therapy with alpha-blockers (tamsulosin) relaxes the ureteric smooth muscle, increasing spontaneous stone passage rates to 70–80% for distal ureteric stones under 5mm. Adequate hydration (2.5–3 litres per day), pain management, and regular follow-up imaging are required. Expectant management is only appropriate if there is no infection, adequate urine flow is maintained, and pain is controlled. 2. ESWL — Extracorporeal Shock Wave Lithotripsy ESWL is a completely non-invasive procedure where high-energy shock waves are focused on the kidney stone from outside the body, fragmenting it into smaller pieces that pass in the urine over days to weeks. No anaesthesia or incision is required — the patient lies on a treatment table for 45–60 minutes. ESWL is most effective for stones 5–15mm in the kidney or upper ureter with good stone density (not hard cystine or calcium oxalate monohydrate stones). Multiple sessions may be required. Stone-free rates are 70–80% for appropriately selected patients. 3. URSL — Ureteroscopy with Laser Lithotripsy A thin, flexible or semi-rigid ureteroscope is passed through the urethra and bladder into the ureter under direct vision — no incisions required. A Holmium laser is then used to pulverise the stone into fine dust or small fragments that pass spontaneously or are extracted with a basket. URSL is the first-line treatment for ureteric stones of all sizes and renal stones up to 15–20mm. Stone-free rates exceed 90% for ureteric stones. A temporary ureteric stent (JJ stent) is typically placed at the end of the procedure and removed after 1–4 weeks. 4. RIRS — Retrograde Intrarenal Surgery RIRS uses a flexible digital ureteroscope that can be deflected to access all parts of the kidney (including the lower pole) through the natural urinary passage — completely scar-free. Combined with Holmium laser lithotripsy, RIRS is highly effective for renal stones 15–25mm and for lower pole stones that are poor ESWL candidates. Stone-free rates of 85–95% are achieved with experienced urologists. Recovery is fast — typically 1–2 days with a JJ stent for 1–4 weeks. 5. PCNL — Percutaneous Nephrolithotomy PCNL is the standard treatment for large renal stones over 20mm, staghorn calculi, and stones in a dilated collecting system. A 1cm incision is made in the back, and a working channel is created directly into the kidney under X-ray or ultrasound guidance. Instruments are inserted to break the stone with ultrasonic, pneumatic, or laser energy and extract the fragments. Mini-PCNL (using a smaller 15Fr tract) and ultra-mini PCNL reduce bleeding risk and recovery time. Stone-free rates exceed 90% for large stones.