Urinary lithiasis.

A M Leal


The introduction of extracorporeal shock wave lithotripsy (ESWL) and the development of "minimally invasive" endourological procedures have completely changed the management of urinary calculi. Nevertheless, some aspects in this field still remain controversial. Conservative management is the first option, when the stone can pass spontaneously. The majority of the patients can be successfully treated with ESWL without anaesthesia and in an ambulatory setting or with a 24 H admission. ESWL failures (1 to 2%) and some difficult calculi (cystine calculi, staghorn calculus, stones of great volume and some ureteral stones) can benefit with endourological or percutaneous procedures alone or in association with ESWL. The classical indication for open surgery has changed significantly and surgery is now considered only in some difficult cases and with the failure of minimally invasive procedures. Uric acid calculi, that usually respond to medical treatment, must be treated with alkalinization therapy as the first option.

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