The role of open stone surgery since extracorporeal shock wave lithotripsy.

Of 893 stone procedures 37 (4.1 per cent) performed during the first 19 months after extracorporeal shock wave lithotripsy was instituted at our medical center were open operations. Procedures included ureterolithotomy in 23 patients (with simultaneous pyelolithotomy in 1), anatrophic nephrolithotomy in 8, pyelolithotomy in 3 (with concomitant pyeloplasty in 2), partial nephrectomy in 2 and nephrolithotomy with a bowel segment inlay in 1. The most common reasons for electing an open operation were unsuccessful endoscopic stone manipulation, presence of anatomical obstruction in the intrarenal collecting system or ureter, morbid obesity and underlying medical problems precluding lengthy repeated endourological procedures. Over-all surgical results were excellent. Our study indicates that patients who presently require an open stone operation have complex calculous disease associated with a variety of anatomical and physiological problems. Despite this finding good results may be attained.