Management of nephrolithiasis: new approaches to "surgical" kidney stones

The majority of kidney stones that come to clinical attention are large enough to cause symptoms but small enough to pass spontaneously. Recent technological developments have revolutionized the approach to kidney stones that heretofore required surgery. Percutaneous removal of stones through a nephrostomy tract, with or without ultrasonic or electrohydraulic lithotripsy, and extracorporeal shock wave lithotripsy (ESWL) have all but eliminated indications for open surgical procedures. These new techniques have their own advantages and are complementary. Despite these advances, any change in accepted indications for stone removal should await further evidence of the long-term safety of percutaneous techniques and ESWL.