Current surgical approaches to nephrolithiasis.

Shock wave lithotripsy is the cornerstone of the modern management of surgical stone disease and is the procedure of choice for small stones in uncomplicated situations. As complexity increases and as the stone size increases, percutaneous lithotripsy becomes more important. Ureteroscopy is preferable for lower ureteral stones and is useful for many mid and upper ureteral stones. Occasional large, complicated stones, or stones that can be reached no other way, require open surgery. Successful management of a wide variety of patients with urinary calculi requires the recognition that multiple forms of therapy are necessary. Identification of the situations best managed by these different treatments will ensure optimal management of patients with surgical stone disease.