ESWL is an effective and noninvasive method of treatment for patients with urinary stones. However, especially in the treatment of larger stones impact of the small stone particles in the lower ureter (steinstrasse) is a serious complication that affects the result of the procedure. If the renal unit has not been catheterized before the ESWL procedure, removal of these particles by open surgical or endoscopic intervention within a very short time is mandatory. A total of 1576 renal unit were treated by ESWL with the Dornier MPL 9000 lithotripter from April 1991 to April 1995. Steinstrasse was observved in 81 patients (5.1%). Of these 81 cases stone fagments passed spontaneously in 56 (69.1%) and were treated successfully with repeat ESWL in 6 (7.4%), ureteroscopic management 14 (17.3%) or open ureterolithotomy in 5 (6.2%). In the treatment of steinstrasse, treatment modality depends on the factors as location and siz e of the fragment, leading larger fragment with following multipl sandy particles and existence of septic symptoms requiring emergency treatment. Prevention is important and recognition that percutaneous nephrostomy, debulking procedures and Double-J stent do not always prevent steinstrasse. Cautionary approaches include maximum debulking before ESWL, attention to the amount of stone burden treated at a single ESWL session and careful timing in cases with significant bilateral disease.

ESWL is an effective and noninvasive method of treatment for patients with urinary stones. However, especially in the treatment of larger stones impact of the small stone particles in the lower ureter (steinstrasse) is a serious complication that affects the result of the procedure. If the renal unit has not been catheterized before the ESWL procedure, removal of these particles by open surgical or endoscopic intervention within a very short time is mandatory. A total of 1576 renal unit were treated by ESWL with the Dornier MPL 9000 lithotripter from April 1991 to April 1995. Steinstrasse was observved in 81 patients (5.1%). Of these 81 cases stone fagments passed spontaneously in 56 (69.1%) and were treated successfully with repeat ESWL in 6 (7.4%), ureteroscopic management 14 (17.3%) or open ureterolithotomy in 5 (6.2%). In the treatment of steinstrasse, treatment modality depends on the factors as location and siz e of the fragment, leading larger fragment with following multipl sandy particles and existence of septic symptoms requiring emergency treatment. Prevention is important and recognition that percutaneous nephrostomy, debulking procedures and Double-J stent do not always prevent steinstrasse. Cautionary approaches include maximum debulking before ESWL, attention to the amount of stone burden treated at a single ESWL session and careful timing in cases with significant bilateral disease.