PURPOSE: The efficacy of percutaneous nephrolithotripsy (PCNL) as a primary therapy for the treatment of lower pole caliceal lithiasis was determined.MATERIALS AND METHODS: We reviewed 144 consecutive files of patients, over a period of 10 years, with noncomplicated lower pole calculi, who underwent PCNL after a single unsuccessful session of extracorporeal shockwave lithotripsy (SWL).RESULTS: The stone-free rate for stones less than 10 mm was 95%. A 97% rate was accomplished for stones between 11 and 20 mm and a 98% rate for stones larger than 20 mm. PCNL achieved a mean overall stone-free rate of 96.7% after a 3-month follow-up, regardless of stone size. PCNL outclasses SWL, when stratified by stone burden and lower pole location. No significant postoperative complications were encountered.CONCLUSION: PCNL is a safe and effective procedure for the management of lower pole caliceal calculi after a single unsuccessful SWL session. This procedure should be considered the primary method for the treatment of lower pole stones.