What is the recommended management for a 1cm asymptomatic stone in the renal pelvis of a fit 40-year-old woman?

The most suitable management for a 1cm asymptomatic stone in the renal pelvis of a fit 40-year-old woman is extracorporeal shock wave lithotripsy (ESWL). This method is minimally invasive and utilizes targeted shock waves to fragment the stone into smaller pieces, which can then pass through the urinary system more easily.

In a patient who is symptomatic or has complications such as infections or obstruction, a more aggressive approach like percutaneous nephrolithotomy or open surgery might be warranted. However, given that this case involves a small, asymptomatic stone, ESWL serves as an effective treatment option that typically requires minimal recovery time and can spare the patient from more invasive procedures.

Observation could be considered for very small stones, particularly below 5mm, where spontaneous passage is more likely. However, for a 1cm stone, the likelihood of spontaneous passage is lower, making proactive management through ESWL a more appropriate choice. Hence, relying solely on observation in this scenario may not be advisable.