Expanding the horizons of SWL through adjunctive use of retrograde intrarenal surgery: new techniques and indications.

The recognition of high retreatment rates and lower success rates after SWL monotherapy in certain situations led us to explore a new endourologic strategy including retrograde intrarenal surgery (RIRS). Examples of situations in which RIRS + SWL is appropriate are coexistence of stones and coagulopathy, stones associated with intrarenal stenosis, concomitant renal and ureteral stones, renal anomalies, and failed SWL. Lithotripter-specific guidelines for the adjunctive use of RIRS may be appropriate.