Mechanical removal is the most appropriate management of this patient's 12-mm kidney stone located in the right renal pelvis. Large (>10 mm) stones are less likely than smaller stones to pass on their own, with or without use of medications to facilitate stone passage. Mechanical stone removal in the renal pelvis is often achieved with shock wave lithotripsy. Stones in the ureter may be addressed with either shock wave lithotripsy or ureteroscopy (often with ureteroscopic lithotripsy), usually depending on the specific location and size of the stone. Percutaneous antegrade ureteroscopy or retroperitoneal laparoscopy is generally reserved for impacted stones or other situations in which less invasive techniques would likely not be successful. Currently, open stone removal is rarely performed. Other indications for mechanical stone removal include stones <10 mm in size that have failed to pass with medical therapy. Involvement of a urologist is recommended for patients with nephrolithiasis who have urosepsis, acute kidney injury, anuria, or refractory pain, as well as those who are at high risk of complications such as having a single kidney, because more invasive interventions may be required in these situations.

Uncomplicated kidney stones <10 mm in size may usually be treated with conservative management (including hydration, analgesia, observation, and periodic re-evaluation) and medical expulsive therapy, which usually consists of either an α-blocker (such as tamsulosin) or calcium channel blocker (such as nifedipine). Although some clinicians may also treat with glucocorticoids in addition to medical expulsive therapy to decrease inflammation and swelling to facilitate stone passage, the effectiveness of this approach has not been documented.