ABSTRACT
The definition of success in the management of kidney stone treatment has undergone a series of metamorphosis over the last 25 years. As early as 1988 (2), residual fragments between 1 and 4 mm following SWL, once thought to be evidence of failure in open or percutaneous therapies, were termed “clinically insignificant” as long as they were asymptomatic and noninfected. Despite the widespread acceptance of this term, there was no consensus within the urologic community as to what constituted a “clinically insignificant” fragment. Furthermore, re-growth rates and symptomatic/interventional episodes for these fragments in long-term studies have been reported to range up to 78% and 43% respectively (Table 14.1). Therefore, most urologists agree that attempts should be made to render a patient stone-free at the time of the first procedure, as any residual stone fragment may require continued radiological monitoring and has the potential for growth or symptoms.
