[Treatment of renal and ureteral lithiasis]

The advent of extracorporal shock wave lithotripsy has entirely changed management of patients with renal or ureter calculi. It is indicated in all types of calculi and generally used as first line treatment. Contraindications are exceptional: pregnancy, uncorrectable coagulation disorders. For staghorn calculi in the kidney, lithotripsy alone is only effective in 50% of the cases and is often completed or preceded by percutaneous nephrolithotomy. Classical surgical procedures may be required in complex cases. Success rate (complete stone free with none residual) with lithotripsy is higher for pelvic stones (70%) and small residual fragments are usually asymptomatic and rarely infected. There is still some debate over indications for ureteral calculi although use of in situ lithotripsy with an ureteral probe. The ureteroscopy is more effective for stones in the distal ureter. In all cases, the final factor in the management decisions is cost-effectiveness.