In this debate article the author presenst arguments for why flexible ureteroscopy (fURS) in the future should not replace SWL. This article should be considered together with another debate article in which the author presents an opposite view [1].

The article initially summarizes results of comparative and randomized studies that to a large extent speak in favour of fURS in terms of therapeutic outcome.

What is further of importance is, however, that the author brings to attention secondary outcomes of SWL. These are discussed under the appropriate heading “beyond stone free rates”. In this section arguments are listed for advantages of SWL: anaesthesia free treatment, quality of life factors, and return to normal daily activities, less need of analgesics, stents and fewer complications.

The combined message in this article shows that SWL has an economically favourable outcome, even in case of lower stone free rates than those seen with URS and fURS. Further improvements in fragment clearance should make the non-invasive approach even more attractive.

Reference
1. Vicentini FCDifference of opinion - In the era of flexible ureteroscopy is there still a place for Shock-wave lithotripsy? Opinion: NO.
Int Braz J Urol. 2015 Mar-Apr;41(2):203-6. doi: 10.1590/S1677-5538.IBJU.2015.02.04.