With extracorporeal shock wave lithotripsy, stone fragmentation and th
e potential creation of residual stones has become an integral part of
the treatment strategy. Therefore, true recurrence, regrowth and pseu
do-recurrence determine the rate of new stone formation. In nonselecte
d series the overall recurrence rate after ESWL varies between 6% afte
r 1 year and 20% after 4 years. The comparison between recurrence rate
after ESWL and the natural recurrence rate reveals that the results o
f ESWL are better than expected. Lithotripsy has no specific effect on
true stone recurrence, and even the pseudo-recurrence is of minor cli
nical significance. Nevertheless, metaphylaxis keeps its place in trea
tment of recurrent urolithiasis.