Optimal management of lower pole stones: the direction of future travel

INTRODUCTION: Kidney stone disease is increasing worldwide with its most common location being in the lower pole. A clear strategy for effective management of these stones is essential in the light of ever increasing choice, effectiveness, and complications of different treatment options. MATERIAL AND METHODS: This review identifies the latest and clinically relevant publications focused on optimal management of lower pole stones. RESULTS: We present an up-to-date European Association of Urology and American Urological Association algorithm for lower pole stones, risks and benefits of different treatments, and changing landscape with the miniaturization of percutaneous stone treatments. CONCLUSIONS: Available literature seems to be deficient on quality of life, patient centered decision making, and cost analysis of optimal management with no defined standard of ‘stone free rate’, all of which are critical in any surgical consultation and outcome analysis.