الفهرس 
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Abstract
Nephrolithiasis is a common complex disease.it is the third most common disaster of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. About 50 % of recurrent stone formers have just one life time recurrence.
This study was conducted in Ain Shams Urology Department and Agouza Hospital Urology Department form December 2016 till September 2017 included all patients complaining of non-lower polar medium sized calyceal stones (1-2 cm).
The study exclude patients with lower calyceal stones, stone burden more than 2 cm, recurrent kidney stones, renal insufficiency, pregnant women and children with kidney stones.
All patients were subjected to preoperative evaluation in the form of Full history taken, physical examination, laboratory investigations. According to study protocol and written consent was taken from all patients prior to procedure verifying that he/she accepts ESWL or PNL with their possible complications, complications of anesthesia according to what are reported in literature then we followed our patients with outcomes, complications and auxiliary procedures.
We concluded that ESWL has advantages of noninvasiveness with less complication rate and higher cost effectiveness. PNL provides significantly higher initial success and lower retreatment rates compared with ESWL. Although PNL is effective, it has some limitations including invasiveness and cost. ESWL is another alternative especially for single moderate-sized high density renal stone.
For treatment of medium sized (1-2 cm) non lower polar renal stone, Both ESWL and PNL have comparable result as regard final SFR and both are complementary to each other. PNL has advantages of higher initial SFR with short time of treatment and lower auxiliary procedures (lower retreatment rate).
We recommend that Patients with medium sized (1-2 cm) non lower polar renal stone underwent non-stented ESWL need further evaluation for the role of stent prior to ESWL.
A HU>1200 is best managed by PNL from the start without the need for auxiliary procedures and HU<1200 can be managed by ESWL.
To include stone analysis, We also recommend to include other treatment modalities; fURS and RlRS and Long follow up regarding stone recurrence and kidney function with larger number of patients still needed to decrease difference percentage.