This protocol addresses kidney stone disease when the stone measures between 10 mm and 20 mm in diameter and is situated outside the lower renal pole — a size range where procedural intervention is typically indicated and the choice of technique materially affects outcomes.
The stone is 10–20 mm in diameter and is not located in the lower renal pole. This size and location profile places the case in an intermediate category where multiple procedural strategies are available, each with distinct stone-free rate and safety profiles.
The procedural options in this scenario span non-invasive fragmentation and endourological approaches. Among the minimally invasive endourological techniques, the evidence indicates that one specific modality achieves a higher stone-free rate in this size range compared with the alternatives — though it carries a different safety and recovery profile.
For stones > 10 mm and < 20 mm, mPCNL achieves a higher SFR than RIRS or SWL, but carries a higher risk of bleeding and is associated with a longer hospital stay; however, there is a high degree of heterogeneity among the included studies.
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