How to treat a symptomatic patient with a renal stone 1 to 2 cm in size?
Apply the therapeutic options in question 31. About 10% to 20% of all kidney stones require surgical removal because of size and symptoms. Many urologists treat symptomatic patients with 1 to 2 cm calcium stones in the renal pelvis or significant proximally obstructing stones (0.5–2.0 cm) with extracorporeal shock wave lithotripsy (ESWL). If the stone is too large or too hard, as estimated with CT, or is not in a good location for ESWL, percutaneous stone removal or a ureteroscopic approach may be indicated (see question 39). Additionally, because of the achievement of higher stone-free rates, many urologists choose percutaneous nephrolithotomy (PCNL) or mini-PCNL for 1- to 2-cm renal stones. Distal ureteral stones > 1 cm are best managed with ureteroscopic stone extraction.