A Child presents with complaints of abdominal colic and hematuria USG showed a renal stone 2.5cm in diameter in renal pelvis the next step in management of this case

ESWL is the treatment of choice for most of the renal calculi which are not able to pass spontaneously, however PNL is the preferred method for larger (>2 cm) renal stones. Campbell's Urology writes- "In summary, for patients harboring nonstaghorn stones smaller than 10 mm, SWL is usually the primary approach. For patients with stones between 10 and 20 mm, SWL can still be considered a first-line treatment unless factors of stone composition, location, or renal anatomy suggest that a more optimal outcome may be achieved with a more invasive treatment modality (PNL or ureteroscopy). Patients with stones larger than 20 mm should primarily be treated by PNL unless specific indications for ureteroscopy are present (e.g., bleeding diathesis, obesity)." Spontaneous passage of stones -- Most stones <5 mm in diameter pass spontaneously. For stones larger than 5 nun in diameter, there is a progressive decrease in the spontaneous passage rate, which is unlikely with stones >10 mm in diameter. The choice of intervention for stones that are unlikely to pass spontaneously varies with the location and size of the stone. Three minimally invasive surgical techniques currently available are: Shock wave lithotripsy (ESWL) Percutaneous nephrolithotomy (PCNL) Rigid and flexible ureteroscopy (URS) Also know Steinstrasse literally means 'stone street' it is condition which follows the use of ESWL. small pieces of fragmented calculi collect and obstruct in the distal ureter, like sand occluding a straw Ref - Bailey and love 27e Kidney , Internet