The management of urinary calculi in a stone centre

We report the management of the first 100 patients who presented with upper urinary tract calculi to The Devonshire Hospital Lithotripter Centre. Ninety-two patients were treated by extra-corporeal shock-wave lithotripsy (ESWL) alone, four by percutaneous nephrolithotripsy (PCN) and two with staghorn calculi by combined ESWL and PCN. Ten patients had ureteric stones, and two of these required conventional open surgery. The average inpatient stay was 3.7 days. Half the patients required no analgesia after ESWL. Of the remainder, most were comfortable with oral analgesia. Almost all returned to normal activity within a few days of discharge. Complications were minimal and were managed by percutaneous or endoscopic techniques. These figures confirm the West German experience that ESWL is a safe and effective urological procedure and requires a skilled back-up of percutaneous and ureteroscopic skills for optimal patient management. By means of these techniques, conventional open surgery is necessary for the treatment of fewer than 5% of cases of calculi in the upper urinary tract.