title: Extracorporeal shockwave lithotripsy vs. percutaneous nephrolithotomy vs. flexible ureterorenoscopy for lower-pole stones.
abstract: OBJECTIVE
  To review previous reports and discuss current trends in extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS). ESWL was recommended as the first-line treatment for small and intermediate-sized stones in the lower pole, while it is the standard treatment for large stones. However, the stone clearance rate after ESWL seems to be lower than that of stones in other locations. This seems to result from a lower rate of fragment passage, due to anatomical factors.
  
  
  METHODS
  Reports on urinary stone disease were reviewed, assessing only publications in peer-reviewed, Medline-listed journals in the English language (publication years 1990-2011).
  
  
  RESULTS
  Recent experience with flexible URS (fURS) for intrarenal stones showed that excellent stone-free rates can be achieved. With increasing experience and technically improved equipment, fURS has become an alternative to ESWL for small and intermediate-sized renal stones. Furthermore, several authors reported successful retrograde treatment for large renal stones, proposing fURS as an alternative to PCNL. However, the major drawbacks are long operating times and commonly, staged procedures, which is why PCNL remains the method of choice for such stones.
  
  
  CONCLUSIONS
  Considering the currents trends and evidence, the 2012 update of the European Association of Urology Guidelines on Urolithiasis has upgraded the endourological treatment of kidney stones. Individual factors such as body habitus, renal anatomy, costs and patient preference must be considered.
authors.affiliation: Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Knoll
authors.affiliation: Lithotripsy and Stone Services, Barts & The London NHS Trust, London, UK.
authors.forename: Noor
authors.initials: N
authors.lastname: Buchholz
authors.affiliation: Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tübingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Wendt-Nordahl
keywords: (f)URS, (flexible) ureterorenoscopy; EAU, European Association of Urology; Extracorporeal shockwave lithotripsy; Lower pole; PCNL, percutaneous nephrolithotomy; Percutaneous nephrolithotomy; SFR, stone-free rate; Ureterorenoscopy; Urinary calculi