<prompt> Management of 4 cm size renal stag horn calculus?ESWLPCNLIntra renal repair surgeryOpen pyelolithotomy  <response>: Ans. b PCNLRef Smith Urology 17th edition, Page page 114; Surgery Sixer 2nd Edition, Page 735 repeat question Latest treatment of such 4cm size Stag horn stone is Sandwich technique--using both ESWL and PCNL. They will break the stone into multiple pieces before and remove by PCNL. 