Impact of extracorporeal shock wave lithotripsy on percutaneous stone procedures.

Extracorporeal shock wave lithotripsy (ESWL) is now the primary urologic treatment for symptomatic renal calculi; it is responsible for a substantial decrease in percutaneous stone removal procedures. Three hundred patients treated since ESWL became available are compared with the preceding 300 patients who were treated percutaneously. Since it became available, ESWL has been used alone on over 90% of patients. The cost of ESWL (average $7500) is similar to that of percutaneous removal procedures, and it causes less morbidity. Percutaneous techniques are still necessary before ESWL is performed (2%) for patients with a large number of stones or staghorn calculi, especially when there is obstruction. Percutaneous techniques alone (2%) may be necessary, especially if high-grade ureteropelvic junction obstruction is present. After ESWL, percutaneous drainage or retrieval of stone fragments may be required (2%). The need for interventional uroradiology persists, although its role is changing. For optimal patient care, the radiologist should provide the urologist with imaging consultation, radiation protection advice, and continued assistance in the less frequently used, though still essential, percutaneous calculus removal techniques.