Urinary stone disease: Great progress with promise for the future

Urinary calculus disease has been a scourge on mankind since ancient times. Research in the field has been hampered by lack of funds and the lack of cachet with the public such as seen with cancer or heart disease. In recent years there have been marked changes led by urologists in the diagnosis, treatment and long-term management of calculi. The vast majority of urinary stones pass spontaneously. Another option has been added with the development of medical expulsive therapy. Yet, further intervention is required in many patients with symptomatic, obstructive or enlarging stones which fail to pass. Standard techniques and studies used in the diagnosis of calculi have included the abdominal radiograph and excretory urogram. Ultrasonography and computed tomography have been added as additional and now standard techniques. In each instance, it is essential to balance the diagnostic information needed and the risks from radiation exposure. The most obvious changes in stone treatment have come with the interventional procedures. The endoscopic approaches have changed with the introduction of small, rigid and flexible ureteroscopes. Simultaneously, there has been development of endoscopic lithotripters which are small enough to fit through these endoscopes. Together these allow access even to intrarenal calculi to offer another alternative in treatment. Percutaneous nephrostolithotomy has been the major technique for treating large renal calculi. Various smaller instruments have been used in a ‘‘mini-perc’’ pattern with variable results. The combination of fully flexible and functioning flexible ureteroscopes with the holmium laser or the electrohy-