Between November 1988 and January 1992, 19,962 renal and ureteral calculi were treated in the United States using 18 different mobile and 2 fixed base Lithostar lithotriptors. Lithotripsy was performed on 11,516 renal and 8,446 ureteral calculi by 750 urologists using the same technique. The success rate (asymptomatic with stone fragments of 4 mm. or less) for renal stones was 87.9%, the stone-free rate was 68.9% and the retreatment rate was 16.5%. Auxiliary procedures were performed in 32.2% of the renal calculi. The success rate for ureteral calculi was 89.5%, the stone-free rate was 83.5% and the retreatment rate was 10.7%. Auxiliary procedures were performed in 25.5% of the ureteral calculi. The overall success rate was 88.4% stone-free rate 75.5%, retreatment rate 14.0% and auxiliary procedure rate 29.4%. Anesthesia personnel were used in 1.9% of the cases. Low energy extracorporeal shock wave lithotripsy was found to be safe and effective.

Between November 1988 and July 1993, 238 renal stones and 208 ureteral stones were treated in 446 pediatric patients using 26 mobile and 2 fixed base Siemens Lithostar lithotriptors. The stones were treated by a group of 245 urologists using the modified Puigvert technique and the standard shock tube. The success rate for renal stones (asymptomatic fragments less than 4 mm.) was 76.6%, stone-free rate was 67.9%, retreatment rate was 14.1% and ancillary procedures were performed in 36.3%. The stone-free rate for ureteral stones was 91.1%, retreatment rate was 3.5% and ancillary procedures were performed in 17.7%. Anesthesia was required in 31% of the renal and 21% of the ureteral procedures. Sepsis in a 6-year-old child after treatment of a ureteral stone was the only major complication. Low energy lithotripsy with the Lithostar in our series of pediatric patients was safe and effective.

Between November 14, 1988 and August 1, 1993, 18,825 ureteral calculi were treated in the United States using 25 different mobile and 2 fixed base Siemens Lithostar lithotriptors. Lithotripsy was performed by 1,012 urologists using the modified Puigvert technique. The overall stone-free rate was 83.8% with a retreatment rate of 10.8%. The stone-free rate varied from 85.8% with stones of 10 mm. or smaller to 67.9% for stones larger than 20 mm. A ureteral stent or catheter was placed before lithotripsy in 19.3% of all treatments and 80.7% had in situ treatment without instrumentation. For calculi of any size, the use of ureteral stents or catheters had no effect on treatment outcome at any ureteral location.

Objective  To determine if the incidence of lower‐pole nephrolithiasis is increasing. Methods  A previously published meta‐analysis of trends in the location of stones in the kidney, using data from 1984 to 1992, determined the percentage of lower pole stones in 26 722 kidney stones treated by extracorporeal shockwave lithotripsy (ESWL). We performed prospective studies on all patients treated by ESWL for a single renal stone (not manipulated from the ureter) in two organizations; at Lithotripters Inc., 47 303 stones were treated with ESWL by 1000 urologists in private practice from 1989 to 1995. At the Midwest Urologic Stone Unit, 9357 stones were treated with ESWL by 200 urologists in private practice from 1987 to 1995. The distribution of stones in both samples was compared with that reported earlier. Results  The meta‐analysis for stone location trends from the previously published article suggested that the percentage of kidney stones in the lower pole at ESWL increased erratically from 1984 to 1989 but was then stable for 3 years. The Lithotripters Inc. sample showed an essentially constant incidence from 28% in 1990 to 30% in 1995, and the Midwest Urologic Stone Unit sample showed an essentially constant incidence from 35% in 1988 to 36% in 1995. Conclusion  The incidence of lower pole nephrolithiasis has remained stable from 1990.