The author lists a number of reasons why SWL in the future will be replaced by flexible ureteroscopy (fURS). This article should be considered together with a debate article in which the author presents an opposite view [1].

Two things need to be commented. It is stated that fURS is taught in residency educational programmes and that residents and young urologists prefer fURS instead of SWL. It seems difficult to understand, however, why good education in one invasive method should exclude another method (non-invasive SWL) for which the education and training generally is poor.

The other presented argument that SWL “occupies a considerable physical space in the hospital” and for that reason should be less useful is difficult to understand. One of the advantages of SWL is that the method, in contrast to endoscopic procedures, does not occupy an operating theatre.

An outpatient procedure (even if repeated), carried out without anaesthesia outside the operating facilities and if properly organized and run by adequately educated and trained operators cannot be more expensive than fURS.

Reference
1. Donaldson JF Difference of opinion - In the era of flexible ureteroscopy is there still a place for Shock-wave lithotripsy? Opinion: YES.
Int Braz J Urol. 2015 Mar-Apr;41(2):199-202. doi: 10.1590/S1677-5538.IBJU.2015.02.03. No abstract available.