Based on optimal efficacy regarding disintegration and stone clearance, combined with minimal invasiveness, extracorporeal shockwave lithotripsy (ESWL) represents the first choice therapy for urolithiasis. Further developments in ESWL have related more to economic aspects than to improvement of disintegration efficacy or reduction of side effects. Routine indications for ESWL are well known and widely accepted. Its limitations are also well established: silent calyceal stones, calyceal diverticula stones, nephrolithiasis in horse-shoe kidneys, medullary sponge kidney, and residual fragments after ESWL. Although endourology provides new, less invasive and traumatic means of stone retrieval or disintegration, including laser lithotripsy, small ureteroscopes and actively deflectable uretero-and pyeloscopes, indications for an aggressive approach in such cases are limited to those who are symptomatic. In the case of distal ureteral calculi ureteroscopy in traureteral laser-induced shockwave lithotripsy open up new and interesting possibilities for the future.
Few technical developments in medicine have contributed so much to the solution of a major medical problem as extracorporeal shockwave lithotripsy (ESWL). More than 10 years after the first clinical application of shockwaves for the treatment of nephrolithiasis, the time is ripe for an analysis of the current and future role of ESWL compared, with endourology. In addition, the question as to whether this ideal therapeutic concept can be improved at all should be considered.