Is there a role for open stone surgery?

Modern day urinary-stone treatment involves procedures and techniques that were not even available 20 years ago. The relatively rapid and sometimes explosive development of ESWL, percutaneous techniques, and ureteroscopy and intracorporeal lithotripsy has ushered in the era of minimally invasive stone management. In many regards, open surgery has such a limited role that its performance often is regarded as a sign of failure. To think of open stone surgery in this manner is likely to do a disservice to a small but important segment of the urinary-stone patient population. The critical responsibility of the urologist treating stone disease is to be able to recognize those clinical situations in which open stone surgery may represent at least a viable and reasonable alternative to less-invasive modalities. The duty of the surgeon is then to be able to present this option to the patient in an unbiased fashion and to effectively perform and implement this form of treatment if chosen. It is only with this approach that open surgery will continue to be correctly applied on those rare occasions and will not become a lost surgical art in the era of minimally invasive surgery.