title: Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial.
abstract: OBJECTIVE
  To present the outcomes of flexible ureteroscopy (F-URS), shock wave lithotripsy (SWL), and observation in the management of asymptomatic lower calyceal stones.
  
  
  METHODS
  A total of 150 patients with asymptomatic lower calyceal stones were randomized into F-URS (group 1), SWL (group 2), and observation (group 3) groups. The main criteria for patient enrollment were having asymptomatic single lower pole stones <1 cm.
  
  
  RESULTS
  In F-URS, the mean stone-free rate was 92% (46 of 50). The mean number of sessions for the SWL group was 1.48 ± 0.65. Stone-free rate was 90% (45 of 50). In the observation group, patients were followed up for a mean of 21.02 ± 3.65 months. Three stones passed spontaneously without any symptoms. Pain developed in 3 patients during follow-up, and 2 of them passed a stone and responded to analgesics without further treatment. Complication rates for groups 1 and 2 were similar, but group 2 had higher Clavien grades.
  
  
  CONCLUSIONS
  For asymptomatic small-sized lower calyceal stones, SWL and F-URS are established treatment modalities. However, with low auxiliary treatment rates, observation may be an option for the management of nonsymptomatic small-sized lower pole kidney stones.
authors.affiliation: Department of Urology, Numune Teaching and Research Hospital, Yuregir, Adana, Turkey. Electronic address: cansener14@gmail.com.
authors.forename: Nevzat Can
authors.initials: NC
authors.lastname: Sener
authors.affiliation: Department of Urology, Onkoloji Education and Research Hospital, Ministry of Health, Ankara, Turkey.
authors.forename: Okan
authors.initials: O
authors.lastname: Bas
authors.affiliation: Department of Radiology, Ceyhan State Hospital, Ceyhan, Adana, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Sener
authors.affiliation: Department of Urology, Bozok University, Yozgat, Turkey.
authors.forename: Kursad
authors.initials: K
authors.lastname: Zengin
authors.affiliation: Department of Urology, Diskapi Yildirim Beyazid Education and Research Hospital, Ministry of Health, Ankara, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Ozturk
authors.affiliation: Department of Urology, Numune Teaching and Research Hospital, Yuregir, Adana, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Altunkol
authors.affiliation: Department of Urology, Numune Teaching and Research Hospital, Yuregir, Adana, Turkey.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Evliyaoglu
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases / Q000628:therapy*; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology / Q000628:therapy*; D007670:Kidney Calices; D008096:Lithotripsy; D008297:Male; D011446:Prospective Studies; D018666:Ureteroscopy; D057832:Watchful Waiting