Retrograde intrarenal lithotripsy (RIRL): limits and possibility

The international guide lines on the urolithiasys indicate the extracorporeal shock waves lithotripsy (ESWL) and the percutaneous nephrolithotripsy (PCNL), alone or in association, as the first step therapy of the kidney stones more than 20 mm. These two techniques had, after two decades of availability, different periods of diffusion and application due to the production of lithotripters of new generation but with a lower efficacy, compared with the gold standard such as the Dornier HM3. At present the improvement of endoscopic devices and intracorporeal lithotripters, such as the Holmium YAG Laser and and the new ultrasonic generation, permit the retrograde approach for the treatment of the kidney stones when the ESWL alone is not indicate and when the PCNL is too invasive.