Please select the eligibility criteria that correspond to the clinical trial below.
Title: Super-Mini Percutaneous Nephrolithotomy (SMP) Versus Retrograde Intrarenal Surgery (RIRS) for Symptomatic Lower Pole Renal Calculi of 10-20 mm Size: a Randomized Controlled Trial (IAU-01)
Brief Summary: Shock wave lithotripsy (SWL) is recommended for kidney stones \< 20 mm. However, the stone clearance of lower pole calculi after SWL is limited, thus leading to an extended indication for mini-percutaneous nephrolithotripsy (PCNL) even for stones between 10 and 20 mm in many centers. This trend is further promoted by introduction of super-mini PCNL (SMP), which is postulated to be less invasive compared to mini-PCNL due to the miniaturized instruments. However, this issue remains controversial.

On the other hand, improvements in endoscopy technology have made retrograde stone removal more attractive. This has led to an increasing use of RIRS as a primary treatment although it is recommended only as 2nd-line option by current guidelines. However, the treatment of symptomatic lower pole calculi is a challenge for RIRS because of lower clearance rates.

The purpose of this study is to evaluate the efficacy and safety of SMP and RIRS for the treatment for symptomatic lower pole calculi renal calculi measuring 10-20 mm.


Options:
A: Inclusion Criteria:

* Patients of both sex with age greater than 18 years to 90 years
* Stone burden between 10 and 20 mm diagnosed by CT scan
* Patient must be agreeable to randomization between shock wave lithotripsy and percutaneous stone removal

Exclusion Criteria:

* Patients with bleeding diathesis or taking anti-platelet or anti-coagulant medication
* Patients who are pregnant based on routine pre-operative pregnancy testing
* Patients with skin to stone size greater than 12 cm (measured routinely on CT scan)
* Patients with either Horseshoe kidney, transplant kidney or a solitary kidney
* Patients with ureteral calculi
* Patients with stone size of \< 10 mm and \> 20 mm
* Ureteropelvic junction obstruction
B: Inclusion Criteria:

1. Age ≥ 18 years
2. Evidence of ureterolithiasis (i.e. stone is located in ureter, not in bladder) as demonstrated on radiographic studies, specifically non-contrast spiral CT.
3. Willingness to participate and able to proceed with standard outpatient management (no personal or job-related issues, e.g. airline pilot.
4. Has a telephone in order to be contacted for follow-up.

Exclusion Criteria:

1. Patient desiring or requiring immediate surgical intervention making then not a candidate for outpatient kidney stone management.
2. Current urinary tract infection based on urine dipstick as admission and urgent procedural management are likely indicated.
3. Known anatomical genitourinary abnormalities or prior Genitourinary surgeries.
4. Positive pregnancy test making proper radiological imaging contraindicated.
5. Breastfeeding mothers.
6. History of hypersensitivity to tamsulosin.
7. Current use of alpha blockers or calcium channel blockers.
8. Current use of steroids which may have an independent effect on stone expulsion.
9. Spontaneous stone expulsion prior to enrollment.
10. Largest stone dimension ≥ 9mm assessed using radiologic imaging, being very unlikely to pass spontaneously.
11. Presence of stone in the bladder.
12. Current use of vardenafil which is tamsulosin contraindicated.
13. Ipsilateral, transplanted or solitary kidney as hospitalization may be necessary.
14. Known renal insufficiency.
15. Fever defined as \>101.5°F which may indicate infection.
16. Floppy iris syndrome which is tamsulosin contraindicated.
17. Planned cataract surgery in the next 60 days which is tamsulosin contraindicated.
18. Prisoners /wards of state.
19. Prior enrollment in STONE (Candidates who are screened and found ineligible may be rescreened at a later date.)
C: Inclusion Criteria:

1. Age 18 to 70 years
2. Normal renal function
3. Anesthesia rating(ASA) score 1 and 2
4. Absence of congenital abnormalities
5. Symptomatic lower pole calculi and diameter 10-20 mm

Exclusion Criteria:

1. Patients with solitary kidney
2. Patients with congenital anomalies, e.g. ectopic kidney, polycystic horseshoe, or mal-rotated kidney
3. Patients who underwent transplant or urinary diversion
4. Uncorrected coagulopathy and active urinary tract infection(UTI)
5. Patient undergoing any other surgical procedure during the same admission. (e.g. ureteroscopy)
6. If patients undergoing RIRS/SMP have purulent urine, we will place D-J stent (for RIRS) or nephrostomy tube (for SMP) and postpone the procedure and excluded the patients from the study
D: Inclusion Criteria:

* The patients who have 2 to 4 cm kidney stones
* ASA score within 1 to 3

Exclusion Criteria:

* Previous surgical treatment including SWL
* Congenital abnormalities

Answer: C