Abstract
Although shock wave lithotripsy (SWL) has provided a major treatment modality for urinary calculi, failures may necessitate repeat sessions or other therapeutic modalities. Endoscopy with laser fragmentation has been particularly useful for treating SWL failures with fragments lodged in the ureter. Proximal calculi can be approached with a flexible ureteroscope. In patients with a percutaneous tube in place, a combination of percutaneous and ureteroscopic approaches can be used in dislodge the upper ureteral fragment and further remove it percutaneously. Midureteral Steinstrasse is particularly difficult to treat by other techniques. With flexible ureteroscopy and laser lithotripsy, the fragments can be reduced to allow endoscopic removal. Distal ureteral fragments are broken and removed with small rigid endoscopes and the pulsed-dye laser. The pulsed-dye laser (Pulsolith) used with both rigid and flexible ureteroscopes has been uniformly successful in removing ureteral fragments after SWL failure.
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