EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY IN THE MANAGEMENT OF UPPER URINARY-TRACT LITHIASIS

The advent of extra-corporal shock-wave lithotripsy in the eighties to tally changed management strategies for renal and ureteral lithiasis o f the upper urinary tract, Currently, approximately 80% of all patient s can benefit from lithotripsy with an overall success rate of about 7 5%. Although classical surgery has a higher succes rate of about 90%, extra-corporal shock-wave lithotripsy has many advantages. First there is a very low risk of morbidity (pain, immobilization, complications) for this outpatient treatment, Second, the overall cost, including th at of preventive treatment, is low as illustrated by the major reducti on in the number of cases of pyonephritis on stones and of corraliform lithiasis. The apparent safety of shock-wave therapy should not mask the risk of unacceptable indications: small stones which may resolve s pontaneously or inversely very large stones carrying the risk of resid ual fragments and renal damage. Long-term morbidity remains to be eval uated, but the management of upper urinary tract lithiasis now relies heavily on shock-wave therapy alongside conventional surgery and percu taneous or endoscopic methods.