Lower pole calculi larger than one centimeter: Retrograde intrarenal surgery

Controversy remains on how to treat lower pole calculi between 1 and 2 cm of size. Treatment options like shock wave lithotripsy (SWL) or percutaneous stone treatment (PCNL) are associated with poor stone-free rates or high morbidity. Due to the ongoing development in endourologic technology, especially in flexible renoscopy, laser technique and grasping devices (tipless Nitinol baskets) retrograde intrarenal surgery (RIRS) has become an option in treating these patients. Based on personal experience and an overview of the published literature we discuss RIRS as a valuable alternative to PCNL in treating patients with larger calculi of the lower pole. The technical developments in laser technology as well as significant improvement in flexible renoscopes have made RIRS for larger lower pole stones possible. The low complication rate gives RIRS for lower pole stones superiority over the invasive percutaneous approach, which is associated with significant morbidity, even in experienced hands.