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Review
. 2023 Aug;24(8):365-370.
doi: 10.1007/s11934-023-01161-w. Epub 2023 Apr 25.

Endourological Options for Small (< 2 cm) Lower Pole Stones - Does the Lower Pole Angle Matter?

Angus Luk  1 , Robert Geraghty  2 , Bhaskar Somani  3
Affiliations
Review

Endourological Options for Small (< 2 cm) Lower Pole Stones - Does the Lower Pole Angle Matter?

Angus Luk et al. Curr Urol Rep. 2023 Aug.

Abstract

Purpose of review: Small renal stones in the lower pole are often difficult to treat. The angle of the lower pole to the renal pelvis (lower pole angle) is a limiting factor to rendering the patient stone free. This review explores the definitions of the lower pole angle, the various treatment options available, and how outcomes are influenced by the angle.

Recent findings: It is clear the lower pole angle definition varies widely depending on described technique and imaging modality. However, it is clear that outcomes are worse with a steeper angle, especially for shock wave lithotripsy and retrograde intrarenal surgery (RIRS). Percutaneous nephrolithotomy has similar reported outcomes to RIRS, and there is limited evidence it may be superior for steeper angles over RIRS. Lower pole stones can be technically challenging and adequate assessment prior to choosing operative approach is key.

Keywords: Lower pole angle; Narrative review; PCNL; Percutaneous nephrolithotomy; URS; Ureteroscopy.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Diagram demonstrating different described methods of measuring IPA. A Bagley; B Sampaio (1992); C Sampaio (1997); D Elbahnasy; E Gupta
See this image and copyright information in PMC

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