Hi, The treatment of kidney stone disease depends on the size and location of stones. Small stones less than 5 mm in size, which are not causing any obstruction, can be managed conservatively with medicines to dissolve the stones. Stones 5 to 10 mm (maximum 15 mm) can be managed with lithotripsy. Stones 10 to 15 mm can be manged with flexible ureteroscopy and laser. Stones more than 15 mm in size should be removed using PCNL (percutaneous nephrolithotomy) which is a keyhole surgery through the back. If the stone is blocking ureter (the tube connecting kidney and bladder) and is 5 to 10 mm in size, it can be treated with medicines to expel the stone. Stones larger than 10 mm usually require endoscopic removal, although occasionally ever a larger stone can be made to pass with medicines. The main issue in a young person like your brother is to find out whether there is an underlying predisposition to form recurrent stones. This is usually evaluated after removal of stones. The removed stone is analysed to find out its chemical composition. You need to check his creatinine, electrolytes, calcium, phosphorus, uric acid and PTH (parathyroid hormone) levels in blood. It is important to check 24 hour urine levels of various salts which either promote or oppose stone formation. These include urinary volume, creatinine, sodium, calcium, uric acid, phosphorus, oxalate, citrate and magnesium levels. Based on these reports we can suggest dietary modifications and specific medications to prevent further stone formation. Meanwhile ask him to drink lot of fluids to keep urine output more than 2 to 2.5 liters per day. Please get back to me with the details of ultrasound report. I can guide you further based on that. Wish your brother a speedy recovery, Warm regards, Dr. Raguram G MS, MRCS, MCh (Urology), Fellow in Endourology