Surgical management

Surgical management of renal calculi depends on stone size and location. Spontaneous passage can be expected for calculi less than 5 mm in diameter, however larger stones are unlikely to pass. Proximal ureteral stones less than 10 mm are preferably treated with extracorporeal shock wave lithotripsy (ESWL), whereas larger stones can be treated with percutaneous nephrolithotripsy (PCNL) alone or in addition to ESWL. For distal ureteral stones, patients can choose between ESWL and ureterolithotripsy. Stones located in the renal pelvis unlikely to pass on their own are treated with ESWL if less than 2 cm or PCNL alone or in combination with ESWL. Open stone surgery is rarely performed today and is reserved for cases where minimally invasive management is contraindicated or has previously failed.