Is lithotripsy better or percutaneous nephrolithotomy better?

Stone size determine: Shockwave lithotripsy minimally invasive, but not very effective for stones larger than 1 cm in diameter, and can not be used for branching "staghorn" stones. Can be used for larger stones if infectious in origin because they break up more easier. Percutaneous is more invasive, but usually a "one shot" procedure to clean out all the stone material.Swl requires minimal to no skill, pcnl needs skill.

It depends: Larger (>20 mm or >10-15 mm in lower pole) stones are probably best treated via percutaneous approach (pcnl). Shockwave lithotripsy (swl) may be less invasive for smaller stones. Swl (and ureteroscopy) may be combined with pcnl to remove all stone material. Pcnl typically requires inpatient hospitalization, more pain, risk of bleeding, but is more likely to result in complete stone clearance.