A variety of minimally invasive options exist for the treatment of patients with upper-tract urolithiasis and as technology advances, so evolve the options. Open stone surgery has been rendered obsolete in most situations, being surpassed by antegrade and retrograde endoscopic techniques, as well as extracorporeal shockwave lithotripsy (ESWL). The challenge facing urologists is the need to balance treatment effectiveness against morbidity, based on each clinical scenario. The aim of the current study is to evaluate the effectiveness of ESWL compared with PCNL for managing moderate size kidney stones measure between 100 and 300 mm2 in area.