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The management of renal calculus disease underwent drastic changes in the early 1980s with the arrival of percutaneous surgery and Shockwave lithotripsy within several years of each other. Previously, patients were managed with an array of open procedures, including pyelolithomy, ureterolithotomy and anatrophic nephrolithotomy. The opportunity to effectively manage renal calculi in a percutaneous manner has drastically reduced patient morbidity when compared to an open, flank approach. Fernstrom and Johansson were the first to describe a percutaneous approach to the renal collecting system for the management of calculi . Much of the early pioneering efforts were performed at the University of Minnesota and were made possible by the arrival of improved equipment and of an effective ultrasonic device that could be used to destroy and remove stones of varying compositions . Although the availability of improved access devices, nephroscopes and lithotrites have made this procedure more facile and safe, the basic principles and techniques have not changed dramatically over the past 20 yr.

In 1976, Fernstrom and Johansson reported the first successful percutaneous nephrolithotomy (PNL) in three patients . Since then, advances in the design of nephroscopes and new methods to fragment large calculi have increased the safety and efficacy of this operation. PNL is an integral part of modern urological training and is widely performed in both academic and community settings . Recently, the American Urology Association (AUA) published its guidelines regarding management of staghorn stones, and PNL holds a central position in the surgical approach for these cases.

Urinary lithiasis is a disease process that predates the Hippocratic Oath . It afflicts males three times more frequently than females with a peak age incidence occurring in the twenties to forties. Most cases of stone disease are not linked to a specific genetic defect and their development is related to multiple external factors, including diet. The main types of stones are composed of calcium, struvite, uric acid, and cystine; the composition of each stone is unique owing to the variety of etiology and patient response to the different therapies available . Medical, as well as surgical therapies, are both used as effective forms of treatment. This chapter will focus specifically on the role of open stone surgery in the treatment of patients with urinary lithiasis.

Minimally invasive antegrade and retrograde techniques combined with extracorporeal Shockwave lithotripsy (SWL) have virtually eliminated open surgery for stone disease. Success rates for treating renal calculi with the above combination approach 100%. The availability of finer instruments with better optical resolution has made the endourological approach the standard of care today. Nevertheless, there exists a category of stones that fail endourologic therapy and thus are candidates for open surgical intervention.

Renal and ureteral calculi comprise the majority of genitourinary calcifications encountered clinically. Significant morbidity, however, may occur from less common urologic calculi. Although treatment of most stones remains uncomplicated, etiology and prevention prove elusive. Mandel hypothesized that most if not all extraosseous calcifications in the body arise from a nidus of carbonate apatite . If this is true, inhibition of the initial crystallization may help prevent formation of most genitourinary stones. Hopefully, future research and investigation will help us understand and eventually direct nonsurgical treatment of these calculi. This chapter discusses the etiology, symptoms, diagnosis, treatment, and prevention of stones found in the urethra, prostate, seminal vesicle, and bladder. The management and prevention of encrusted foreign bodies is also presented.