In the decades, since the advent of shockwave lithotripsy, instrumentation and techniques in both ureteroscopic and percutaneous stone management have improved exponentially, leading to both increased success and lower complication rates. As a result, there have been some controversies revolving around the therapeutic modality of choice for specific stones in terms of their size and location. This review seeks to provide some clarity to the decision-making process with emphasis on patient comfort and choice and due consideration being given to the potential complications associated with the various treatment modalities.