title: [Modern urinary stone therapy: is the era of extracorporeal shock wave lithotripsy at an end?].
abstract: BACKGROUND
  Treatment of urolithiasis saw major changes with the introduction of extracorporeal shock wave lithotripsy (ESWL) and percutaneous and ureteroscopic techniques in the 1980s. Since then these minimally invasive treatment modalities have continuously been developed further.
  
  
  RESULTS
  For years ESWL has been the treatment of choice. However, recent years have seen a significant shift towards endoscopic therapies. This can be attributed to the evolving surgical experience in the use of these techniques, but even more to major improvement in the technical equipment. This trend is not backed sufficiently by high-level data (RCTs). Some of the newer data on endoscopic techniques are presented in cohort studies, but most studies are case series. Accordingly, recommendations of the German and international guidelines still focus on ESWL as first-line therapy for most locations and sizes of urinary stones.
  
  
  CONCLUSIONS
  The analysis of treatment data of our institution confirms these trends and demonstrates high treatment efficiency in modern stone management and a consecutive significant lowering of socio-clinical expenses.
authors.affiliation: Abteilung Urologie, Chirurgische Universitätsklinik, Universitätsklinikum Freiburg, Hugstetterstraße 55, 79106 Freiburg, Deutschland. arkadiusz.miernik@uniklinik-freiburg.de
authors.forename: A
authors.initials: A
authors.lastname: Miernik
authors.forename: K
authors.initials: K
authors.lastname: Wilhelm
authors.forename: P
authors.initials: P
authors.lastname: Ardelt
authors.forename: S
authors.initials: S
authors.lastname: Bulla
authors.forename: M
authors.initials: M
authors.lastname: Schoenthaler
mesh_terms: D004059:Diffusion of Innovation; D005544:Forecasting; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000639:trends*; D009403:Nephrostomy, Percutaneous / Q000639:trends*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy / Q000639:trends*