Published online Jul 24, 2014. doi: 10.5410/wjcu.v3.i2.81
Revised: April 25, 2014
Accepted: May 29, 2014
Published online: July 24, 2014
The prevalence of urolithiasis has been observed to increase during last decades. Kidney stones over 2 cm in diameter are the common urologic problem. European and American Associations of Urology has published guidelines on Urolithiasis and presented the most effective tools to treat large stones. On the other hand many experienced endourologic centres choose other modalities from their armamentarium. All treatment methods are characterized by their efficacy and safety which are usually inversely proportional. It is crucial for patients and physicians to find a golden mean. Percutaneous lithotripsy is still considered treatment of choice with more than 95% efficacy. Less invasive retrograde intrarenal surgery is also less effective, but burdened with lower complication rate. Extracorporeal shockwave lithotripsy is feasible in paediatric patients with acceptable stone free rates. Open surgery (pylolithotomy and anatrophic nephrolithotomy) are almost obsolete techniques. All methods have their pros and cons. Physicians should share decisions regarding treatment modalities with patients.
Core tip: There are various modalities for treatment of kidney stones over 2 cm in diameter. Guidelines indicate the most appropriate methods. Percutaneous lithotripsy is considered first line treatment while retrograde intrarenal surgery or shockwave lithotripsy are optional approaches. Apart from guidelines physicians should share decisions regarding optimal treatment with patients.