Introduction: Due to the increasing spread and technical enhancement of endourological methods, open surgery for renal and ureteral calculi almost disappeared.
Materials and methods: Based on an actual review of literature, we describe indications, technique and clinical importance of the open and laparoscopic management of urolithiasis.
Results: In Europe and Northern America, the surgical therapy of urolithiasis only plays a role in cases of very large or hard stones, after failure of shock wave lithotripsy, percutaneous nephrolithotripsy or ureteroscopic stone removal and in cases of abnormal renal anatomy. However, in emerging markets with different structures and funding of the health care system and with a limited access to endourological procedures, these techniques still have a higher importance. Particularly in Europe laparoscopic surgery is emerging because calculi can be removed from almost all locations within kidney and ureter using a transperitoneal or retroperitoneal access. Functional outcomes and complication rates are comparable to open surgery. The benefits of laparoscopy are: less postoperative pain, shorter hospital stay, faster reconvalescence, and better cosmetic results.
Conclusions: Although open and laparoscopic removal of renal and ureteral calculi is only performed in a limited number of cases in daily urological practice, they may be superior to the endourological techniques in some circumstances. Therefore, they should be considered as a part of the urological armamentarium.