What are the options to remove a kidney stone if it is as big as a crab apple?

Multiple.: A stone that size is not going to be amenable to the standard lithotripsy techniques. An important question is if there is any function left in the kidney. If not, the kidney is not doing any good except serving as a potential source of serious infection, and should be removed surgically. If the kidney should be saved, the stone can be removed surgically or by percutaneous nephrolithotomy.

Multiple: If a large stone is in the kidney, the urologist may recommend a percutaneous nephrolithotomy (pnl) where the stone is blasted with an energy device that is inserted through a small incision in the flank. Some stones 2, .5cm or less would respond the shock wave therapy. Also, a ureteroscopy could be performed, with the understanding that the patient may need additional procedures to be stone free.