A 35 years old male patient develops colicky pain in the abdomen. He has got a 3cm stone in renal pelvis. There is no hydronephrosis and no obstruction distally and his renal parameters are normal. What is the management of choice in this patient?
Percutaneous nephrolithotomy is the management of choice in this patient. PCNL is indicated in the removal of renal and proximal ureteric calculi greater than 2.5cm in size, resistant to ESWL and in instances with evidence of obstruction. Indications for ESWL are: renal pelvic stones less than 2cm, lower pole stones less than 1cm, upper ureteric stones less than 1cm and in sandwich therapy in conjunction with PCNL. Indications for ureteroscopic removal of calculi are: ESWL failure, impacted calculi, stones more than 1cm, multiple stones, associated with distal obstruction, solitary kidney and in bilateral ureteral calculi.
ESWL
PCNL
Open pyelolithotomy
Dissolution with oral potassium solution