Lower Pole Renal Calculi: When and How to Treat

This article addresses the respective roles of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), open surgery and laparoscopy as they pertain to the management of lower pole calculi, an area of ongoing controversy. Lower pole stones that are symptomatic, locally obstructing, infection related, or increasing in size require intervention. Smaller, asymptomatic stones can be managed expectantly, though with periodic followup a significant number will exhibit increasing size or become symptomatic. For most stones smaller than 1 cm, SWL is the treatment of choice while for stones greater than 2 cm, percutaneous management is generally indicated. Stones in the range of 1 2 cm represent an area of ongoing controversy regarding respective roles of SWL, PCNL and ureteroscopy. In such cases, consideration should also be given to intrarenal anatomy and stone fragility in determining appropriate therapeutic intervention.