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Background and Aim: The goal of lower pole calculus (LPC) management is to achieve maximal stone clearance with minimal morbidity Management of LPC is still a dilemma for the urologist. Both PCNL and SWL are done routinely in Department of Urology at Medical Foundation. This has led us to study and compare efficacy of Shock Wave Lithotripsy (SWL) and Percutaneous Nephrolithonomy (PCNL) in management of solitary LPC of 10mm to 20mm size. Material and Methods: A total of 60 patients coming to the medical Hospital were recruited in this prospective study. In all patients, a detailed history was taken and a physical examination was done. Routine laboratory investigations were done. Radiological evaluation was done in the form of plain X - ray of kidney, ureter and bladder (KUB) and ultrasound of the abdomen. Patients were asked to choose any one, out of 60 34 patients chose SWI and 26 chose PCNL. Number of shock waves used and number of sessions required, cumulative procedure time that is total time taken in all the session required to treat one patient was calculated. Any complication or need for any ancillary treatment was also noted. Results: There is no significant difference in the stone size (mm) between the SWL group and PCNL group. Mean LIA was found to be 53.22 and 54.96 in SWL and PCNL group respectively. Mean IW was found to be 6.75 mm and 6.25 mm in SWL and PCNL group respectively. Mean IL was found to be 19.59 mm and 19.54 mm in SWL and PCNL group respectively. There is no significant difference in the IL between the SWL group and PCNL group. Conclusion: SWL achieves similar stone free rates as compared to PCNL. It is advantageous over the PCNL in terms of procedure time. However other than stone size LIA may have impact on stone clearance but is not statistically significant. SWL has more complications in treating > 15mm stone than in treating < 15mm stone. [ABSTRACT FROM AUTHOR]