Difference of opinion--In the era of flexible ureteroscopy is there still a place for Shock-wave lithotripsy? Opinion: YES.

The prevalence of urolithiasis has increased to 8.8% in the United States of America, due to diet and lifestyle changes and associated increasing diabetes and obesity (1). Urinary stones represent a significant economic burden both directly (treatment associated costs) and indirectly (e.g. time off work) (2). The emergence of a non-invasive intervention in 1980, shock wave lithotripsy (SWL), revolutionised the treatment or urinary calculi (3). Miniaturisation and refinements to endourologists’ armamentarium over the past two decades have increased the efficacy and application of endoscopic stone management. The lower renal pole calyces can now be accessed with “near certainty” using modern flexible ureteroscopes (4). However, innovation and refinement to the technology and technique used for SWL have also improved its efficacy and reduced associated side-effects in recent decade (5). The optimal treatment modality for renal and ureteric calculi is therefore controversial (6).