Alam R. et al., 2021: Contemporary considerations in the management and treatment of lower pole stones.
Alam R, Matlaga BR, Alam A, Winoker JS.
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA.
The presence of lower pole stones poses a unique challenge due to the anatomical considerations involved in their management and treatment. Considerable research has been performed to determine the optimal strategy when faced with this highly relevant clinical scenario. Standard options for management include observation, shock wave lithotripsy, retrograde intrarenal surgery, or percutaneous nephrolithotomy. Indeed, each approach confers a distinct set of risks and benefits, which must be placed into the context of patient preference and expected outcomes. The current state of practice reflects a combination of lessons learned from managing calculi not only in the lower pole, but also from other locations within the kidney as well.
Int Braz J Urol. 2021 Mar 11;47. doi: 10.1590/S1677-5538.IBJU.2021.0010. Online ahead of print. PMID: 33861542 Review. FREE ARTICLE
Nothing new or not yet stated in guidelines:”While SWL is an important and useful option in the treatment of lower pole urolithiasis, it is rather universally accepted that larger calculi, particularly those >10mm, should not be treated using this modality as a first-line option.”