Every nephron deserves a second chance before nephrectomy in obstructed uropathy due to urolithiasis.

Intractable flank pain might be a predictor of functioning renal parenchyma in hydronephrotic/atrophic kidneys. Renal split function lower than 10% on DMSA scintigraphy might not be an absolute indication of nephrectomy, especially in the obstructed renal unit. Evaluation of renal function after eliminating obstruction might be more reliable.