Open or laparoscopic surgery is no longer commonly used for the treatment of stones in the United States. There are still however specific situations where these approaches are indicated including anatomic abnormalities such as in ureteropelvic junction obstructions. In these situations, treatment of the primary problem is indicated to prevent future stones from re-developing.
Laparoscopic surgery for stones is still commonly performed in less developed countries, primarily due to issues of costs in repairing the delicate ureteroscopes or obtaining the expensive shockwave lithotripsy machines which have now largely replaced open or laparoscopic surgery in more affluent countries.
Historically, open stone surgery was first performed for bladder stones in men. Bladder stones were more common historically than they are now because of improved treatment for benign prostatic hyperplasia, or BPH, which can lead to impaired drainage, infections, and the eventual formation of bladder stones. Nowadays, in the few situations where a patient presents with a large bladder stone, open stone surgery may still be the best option for quickly and completely removing it.