Urolithiasis is the most common and important disease in the field of Urology, and recently the incidence of urolithiasis has increasing tendency according to the improvement of living condition in Korea. In the management of urolithiasis, open surgery was done mainly until several years ago. But not with the development of extracorporeal shock wave lithotriptor (ESWL), endourology and other new instruments, the urolithiasis is easily treated, not surgically.

The author analyzed patients with urolithiasis who had been admitted to Ewha Womans University Hospital from April 1976 to December 1995 to know the change ofoccurrent trend and treatment for urolithiasis for the past 20 years.

The following results were obtained ;

1) During the periods, 3,069 cases were urolithiasis(31.1%) of the 9,868 total admitted patients in urology. The total number and rate of incidence were increased constantly especially until late eighties, but since the year of 1991 those were slightly decreased.

2) The sex ratio of male to female was not changed significantly. The occurrent rate under age of 20 years old was decreased but increased after 6th decades. The seasonal occurrence was the highest in summer until 1985, but after then there was no seasonal difference.

3) The incidence of ureter, bladder and urethral calculi was decreased but that of renal calculi was increased.

4) In the management, the open surgery and expectant therapy were decreased after October 1986, but the rate of nephrectomy was slightly increased. In endourological management, the success rate of ESWL, PNL and URS was 92.8%, 86.6% and 96.7% respectively.

For the past 20 years, the trend of urolithiasis was changed and modalities of treatment were changed, especially since the late of 1980s.

It is important to improve treatment efficacy in the management of urolithiasis in respect of time saving cost effectiveness. An experimental study reported that optimal fluid act as an interface between stone and urothelium improves fragmentation. We investigated the effect of diuretic usage in the SWL treatment of urolithiasis.

Sixty renal stone patients were selected for the prospective randomized double blind study. Patient in group A were given a placebo injection and patient in group B were given 20mg IV furosemide at the time of SWL treatment. Both groups received standard SWL monotherapy using Modulith SLX2000 lithoclast(Storz®, Germany). The energy setting, number of shock waves per session were identical in both groups. Treatment results were compared three weeks later after the first SWL treatment.

Mean age of the patients was 44.5±11.3 years old in group A, and 43.1±11.5 years old in group B. Mean size of the calculus before treatment were 9.2±4.8, and 8.9±5.1mm, which did not shown any statistical difference(p>0.05). Three weeks after the treatment, stone fragmentation and stone free rate was significantly higher in group B(p<0.05).

This study suggest that administration of furosemide intravenously during SWL improve stone fragmentation and stone free rate.