58. Management of Residual Stone Fragments

  1. Arthur D. Smith MD2,
  2. Gopal H. Badlani MD3,
  3. Glenn M. Preminger MD4 and
  4. Louis R. Kavoussi MD2,5
  1. Andreas Skolarikos MD, PhD, FEBU

Published Online: 5 JAN 2012

DOI: 10.1002/9781444345148.ch58

Smith's Textbook of Endourology, Volume I&II, 3rd Edition

Smith's Textbook of Endourology, Volume I&II, 3rd Edition

How to Cite

Skolarikos, A. (2012) Management of Residual Stone Fragments, in Smith's Textbook of Endourology, Volume I&II, 3rd Edition (eds A. D. Smith, G. H. Badlani, G. M. Preminger and L. R. Kavoussi), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444345148.ch58

Editor Information

  1. 2

    North Shore–Long Island Jewish Health System, The Arthur Smith Institute for Urology, New Hyde Park, NY, USA

  2. 3

    Institute of Regenerative Medicine, Wake Forest University Baptist Medical Center, Winston Salem, NC, USA

  3. 4

    Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA

  4. 5

    New York University School of Medicine, New York, NY, USA

Author Information

  1. Athens Medical School, 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece

Publication History

  1. Published Online: 5 JAN 2012
  2. Published Print: 1 FEB 2012

ISBN Information

Print ISBN: 9781444335545

Online ISBN: 9781444345148



  • residual stone fragments;
  • shock-wave lithotripsy;
  • percutaneous nephrolithotomy;
  • ureteroscopy


Residual stone fragments are common following definitive treatment of renal or ureteric stones. Studies on the natural history of remaining fragments following shock-wave lithotripsy (SWL), percutaneous nephrolithotomy or ureterolithotripsy indicate that the term clinically insignificant residual fragments could be a misnomer. Every effort should be made to ensure a stone-free status following treatment. Recent advances in technology have been highly effective in preventing residual fragment creation. Accurate post-procedural identification of residual stones is mandatory, with computed tomography being the more sensitive diagnostic modality. Surgical management in the form of a repeat SWL, second-look flexible nephroscopy or ureterorenoscopy may be needed for the management of remaining stones. Medical therapy may control active stone formation, reduce growth or agglomeration, and increase the clearance rate of residual fragments.