Fever with a kidney stone is a urologic emergency. Do not wait for an appointment.

Call 911 or Go to the ER Immediately

Kidney Stone Treatment · University Urology, PC

Kidney Stone Specialists in Knoxville — Fast Access, Advanced Care

Acute stone pain shouldn’t mean a trip to the ER and a months-long wait. We offer rapid access for urgent stone cases, advanced minimally invasive treatment, and a prevention program to keep stones from coming back.

Call Now: (865) 305-9254 Message Us on Klara
24–48 hrs
Typical access for acute stone pain
2
Fellowship-trained endourologists
11
Locations across East Tennessee

East Tennessee’s Stone Specialists

High-Volume Stone Care — From Acute Pain to Long-Term Prevention

University Urology has more fellowship-trained endourologists than any other practice in East Tennessee. That matters when your stone is large, recurrent, or in a location that makes straightforward treatment impossible. Our urologists manage the full spectrum — from simple ureteral stones that may pass with medical therapy to complex staghorn calculi requiring percutaneous surgery.

We maintain dedicated acute stone access slots, and our on-call urologist is available 24/7 for urgent situations. Same-week surgical scheduling is available for stones that require intervention. After treatment, our prevention clinic uses 24-hour urine testing and stone analysis to identify the metabolic cause and reduce your risk of recurrence.

How Urgent Access Works

Stone Pain? Here’s What Happens Next.

  • 1
    Call or Message UsStone calls are triaged immediately. Tell the scheduler you have acute stone pain — dedicated same-week slots are held for these cases.
  • 2
    Bring Your ImagingIf you have a recent CT scan from an ER or urgent care, bring the disc or have it sent. This allows us to plan treatment at your first visit.
  • 3
    Treatment Decision Same VisitYour urologist reviews imaging, discusses options, and — if surgery is needed — schedules it the same week in most cases.
  • 4
    Prevention Follow-UpAfter your stone passes or is removed, we offer 24-hour urine testing and a prevention plan to lower your risk of forming another.
Call (865) 305-9254

Symptoms

Recognizing Kidney Stone Symptoms — and When It’s an Emergency

Most kidney stones cause recognizable symptoms. Some require urgent outpatient evaluation. Others are a true emergency requiring immediate ER care.

Common Kidney Stone Symptoms

  • Severe, cramping flank or back pain (renal colic)
  • Pain that radiates to the groin or lower abdomen
  • Blood in the urine (pink, red, or brown)
  • Nausea and vomiting with pain
  • Frequent or urgent urination
  • Pain with urination
  • Difficulty passing urine

Go to the ER Immediately If You Have:

  • Fever or chills with flank pain — this indicates infected obstruction, which can be life-threatening
  • Uncontrolled pain or vomiting despite medication
  • Inability to keep any fluids down
  • Known single kidney with stone obstruction
  • Signs of sepsis: confusion, rapid heart rate, extreme weakness

Treatment Options

Advanced Minimally Invasive Stone Treatment

The right treatment depends on stone size, location, composition, and your anatomy. We offer every minimally invasive option — and the high-volume surgical experience to achieve stone-free outcomes with minimal recovery time.

Conservative

Medical Expulsive Therapy

For smaller ureteral stones with manageable pain, targeted medications (alpha-blockers) and close follow-up can help facilitate stone passage without surgery. Appropriate patient selection is key.

  • Best for stones under 6–7mm in the distal ureter
  • Combines medication with hydration and pain control
  • Weekly follow-up to confirm passage or escalate treatment
Most Common Procedure

Ureteroscopy + Laser Lithotripsy

A thin, flexible high-definition digital ureteroscope is passed into the ureter or kidney without incisions. Laser energy (holmium or thulium fiber laser) fragments the stone, and pieces are removed to achieve a stone-free result.

  • No incisions — outpatient procedure
  • Effective for ureteral and kidney stones of most sizes
  • High-definition digital scopes for superior visualization
  • Holmium and thulium fiber laser technology
  • Return to normal activity typically within a few days
Outpatient

Shock Wave Lithotripsy (ESWL)

External focused sound waves break select kidney or proximal ureteral stones into small fragments that pass naturally. No anesthesia or incision required for most patients. Appropriate stone selection is important for good outcomes.

  • Non-invasive — no scope or incision
  • Best for smaller kidney or proximal ureteral stones
  • Outpatient with quick recovery
  • Stone composition and anatomy affect candidacy
Complex Stones

Mini-PCNL (Percutaneous Nephrolithotomy)

For large-burden kidney stones, staghorn calculi, or stones that have failed other treatments, mini-PCNL provides direct access to the kidney through a small back incision. Our high-volume endourologists achieve excellent stone-free rates with the mini technique, which reduces blood loss and recovery compared to standard PCNL.

  • Performed by Dr. Pickens and Dr. Riedinger — high-volume PCNL surgeons
  • Mini approach reduces incision size and recovery time
  • Best for stones >15–20mm, staghorn calculi, or complex anatomy
  • Typically requires short hospital stay
Urgent

Stents & Nephrostomy Drainage

When an obstructing stone causes infection, significant hydronephrosis, or compromises kidney function, temporary drainage is placed urgently to relieve pressure and protect the kidney. This can be done as a same-day procedure in most cases.

  • Ureteral stent or nephrostomy tube placed same day when needed
  • Relieves obstruction and treats infection before definitive stone treatment
  • Followed by staged ureteroscopy or PCNL once infection clears
Prevention

Stone Prevention & Metabolic Workup

Kidney stones recur in up to 50% of patients within 5 years without intervention. Our prevention program identifies the metabolic cause of stone formation and creates a personalized plan to reduce your risk.

  • 24-hour urine collection and analysis
  • Stone composition analysis (when stone is available)
  • Dietary counseling tailored to your stone type
  • Medication when dietary changes alone are insufficient
  • Serial monitoring to track response

Why University Urology

East Tennessee’s Highest-Volume Stone Practice

Stone disease is one of our highest-volume specialties. We welcome referrals from regional urologists, emergency departments, and primary care for complex cases.

24–48 Hour Urgent Access

Dedicated acute stone slots are held each week. Stone calls are triaged immediately, and surgical scheduling is expedited for cases that can’t wait.

Two Fellowship-Trained Endourologists

More subspecialty-trained stone surgeons than any other practice in the region. Dr. Pickens and Dr. Riedinger handle complex cases; all urologists manage straightforward stone disease.

Advanced Laser Technology

High-definition digital ureteroscopes with holmium and thulium fiber laser systems — the current standard for stone fragmentation and dusting.

High-Volume Mini-PCNL

Complex and large-burden stones require high case volume for optimal outcomes. Our endourologists perform more PCNLs than any other group in East Tennessee.

Prevention Program

We don’t just treat the stone — we look for the cause. Our metabolic workup and prevention clinic helps patients who form stones repeatedly break the cycle.

11 Locations, 24/7 On-Call

Satellite clinics across East Tennessee for follow-up and routine care. On-call urologist available after hours for urgent situations.

Our Stone Specialists

Fellowship-Trained Endourologists for Complex Stone Disease

Complex and high-volume stone cases are led by our fellowship-trained endourologists. All University Urology physicians manage routine kidney stone disease.

RP

Dr. Ryan Pickens, MD

Endourology · Advanced Stone Surgery · Aquablation

Fellowship-trained endourologist with primary clinical focus in complex kidney stone disease, PCNL and mini-PCNL, ureteroscopy, and BPH. High-volume stone surgeon and the only physician in East Tennessee performing Aquablation for BPH.

Full Profile →
ER

Dr. Eric C. Riedinger, MD

Endourology · Advanced Stone Surgery · Large Prostates

Fellowship-trained endourologist (Ohio State) with subspecialty expertise in complex kidney stone management, PCNL, mini-PCNL, ureteroscopy, and advanced BPH procedures for large glands. Sees patients at UTMC and Tazewell satellite clinic.

Full Profile →

All University Urology physicians treat kidney stones — including Drs. Angelle, Bienvenu, White, Kim, and Lacy. Routine stone disease, follow-up, and acute evaluation can be managed across our full team. Complex cases, large-burden stones, and PCNL are referred to Drs. Pickens and Riedinger.

For Referring Providers

We welcome urgent referrals from emergency departments, urgent care centers, and primary care and specialty practices across East Tennessee. We provide rapid feedback after evaluation and coordinate imaging and surgical scheduling for your patients.

Urgent Referrals

Call (865) 305-9254 and identify as a referring provider with an acute stone patient. Dedicated same-week slots available.

Fax Referrals

Fax to (865) 244-1611. Include imaging reports and any CT disc or transfer if available. We will contact the patient directly.

Complex Stone Referrals

Large stone burden, staghorn calculi, anatomy-complex stones, or patients who have failed treatment elsewhere — refer directly to Dr. Pickens or Dr. Riedinger.

After-Hours Urgent Cases

On-call urologist available 24/7 at (865) 305-9254. For infected obstructing stones, direct to UTMC ER with urology consult.

Frequently Asked Questions

Common Questions About Kidney Stone Treatment

How quickly can I be seen for acute stone pain?
We triage stone calls immediately and hold dedicated acute access slots each week. Most patients with acute stone pain are seen within 24–48 hours. Call (865) 305-9254 and tell the scheduler you have active stone pain — do not schedule online for this, as phone triage allows us to prioritize appropriately.
When does a kidney stone need surgery vs. passing on its own?
Stones smaller than 6mm in the distal ureter have a reasonable chance of passing with medical expulsive therapy. Stones larger than 7–8mm, stones in the kidney or proximal ureter, stones causing infection or significant obstruction, or stones that have not passed after 4–6 weeks typically require intervention. Your urologist will review your CT and discuss the most appropriate approach at your visit.
What is a ureteral stent, and will I need one?
A ureteral stent is a small soft tube placed inside the ureter to keep it open and allow urine to drain around or past an obstructing stone. Stents are placed when a stone is causing infection or significant kidney damage requiring urgent drainage before definitive treatment. They are also placed after ureteroscopy in many cases to allow healing. Stents cause urinary frequency, urgency, and sometimes discomfort — they are temporary and removed in office once no longer needed.
What is mini-PCNL and how is it different from standard PCNL?
Percutaneous nephrolithotomy (PCNL) accesses the kidney directly through a small incision in the back to remove large or complex stones that cannot be treated with ureteroscopy. The “mini” technique uses smaller instruments than traditional PCNL, reducing blood loss, post-operative pain, and recovery time while maintaining high stone-free rates. It is the preferred approach for stones larger than 15–20mm, staghorn calculi, and cases requiring complete stone clearance in a single procedure.
Why do I keep forming kidney stones?
Recurrent stone formation almost always has an identifiable metabolic cause — including hypercalciuria, hyperuricosuria, low urine volume, hyperoxaluria, or hypocitraturia. A 24-hour urine collection identifies the specific abnormality. Treatment — whether dietary modification, increased fluid intake, or medication — is targeted at correcting that specific defect, not a one-size-fits-all approach. Without a metabolic workup, recurrence rates remain high regardless of how many stones we remove.
Does insurance cover kidney stone treatment?
Yes. Ureteroscopy, ESWL, PCNL, and ureteral stent placement are covered by Medicare and virtually all commercial insurance plans when medically indicated. The metabolic workup and prevention visit are also covered under most plans. We verify your coverage before scheduling any procedure.

Kidney Stone Pain? Don’t Wait.

Call us now for rapid access. Acute stone slots available within 24–48 hours. Surgical scheduling same week when needed.

Call (865) 305-9254 Message Us on Klara Text (865) 459-8448 Find a Location

Preparation Instructions

Preparing for Your Procedure

If you have a kidney stone procedure scheduled, review your preparation instructions below. Select the procedure that applies to you.

Hospital Surgery

Ureteroscopy with Laser Lithotripsy

Scope-based stone fragmentation at UTMC. PAT testing, medications, fasting, and recovery.

View preparation instructions → Hospital Surgery

Percutaneous Nephrolithotomy (PCNL)

For large or complex stones. PAT testing, medications, fasting, and recovery instructions.

View preparation instructions →