Effectiveness and safety of ultra-slow full power shockwave lithotripsy compared to mini–percutaneous nephrolithotomy and retrograde intrarenal surgery for treatment of lower calyceal stone between 1 and 2 cm with high attenuation value

Mini-PNL achieved higher SFR, its invasiveness and radiation exposure warrant consideration. However, the comparison between RIRS and ultraslow SWL success suggests ultraslow SWL may benefit patients with moderately sized lower pole stones with high attenuation values, especially who wish to avoid invasive surgery or are considered unfit for anesthesia. The results are encouraging but preliminary and require confirmation. However, some limitations were heterogeneous follow-up imaging intervals, absence of anatomical data, lack of stone composition analysis, and baseline stone volume imbalance. Therefore, future studies should evaluate long-term outcomes and cost-effectiveness, and consider our limitations.