Present role of surgery

Abstract

The advent of more advanced endoscopic methods and extracorporeal lithotripsy (ESWL) plus the increasing use of radiological means such as ultrasound, which has allowed the bloodless treatment of small stones, have gradually reduced the number of traditional surgical operations. In one decade surgery has dropped from 63% (1983-1985) to 3.6% (1993-1995) in stone cases, mainly following unsuccessful ESWL or endoscopic methods. It is rarely first choice in lumbar calculosis unlike in voluminous obstructing iliac calculosis, while it is exceptional in cases of pelvic stones. Surgery may be “necessary”, however, with associated ureteral stenosis or anatomical alterations preventing endoscopic or percutaneous approaches and contemporaneousness of surgical operations. Occasionally circumstances, such as working conditions or the psychological state of the patient, “condition” the choice for an immediate, final solution by a single procedure. Lastly, surgery should be reserved today for selected cases and when used, should be highly competitive, from all points of view, compared to all other methods.