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COMPOSIZIONE E DUREZZA DEL CALCOLOLa composizione chimica del calcolo influenza la sua durezza e quindi può spiegare i diversirisultati descritti con la ESWL nel trattamento di calcoli di dimensioni sovrapponibili. Calcolidi ossalato di calcio diidrato e di acido urico puro sono maggiormente suscettibili di frammentazionerispetto a calcoli di ossalato monoidrato e di cistina 12 . Per tale motivo, attualmente,è stato suggerito che il limite, per i calcoli di cistina da trattarsi con ESWL, non sia>15 mm; mentre per calcoli di dimensioni superiori è raccomandata la PNL in monoterapiao associata all’ESWL 44-46 .Bibliografia1. Miller NL, Lingeman JE. Management of kidney stones. BMJ 2007; 334(7591): 468-72.2. Wen CC, Nakada SY. Treatment selection and outcomes: renal calculi. Urol Clin North Am 2007; 34(3):409-19.3. Galvin DJ, Pearle MS. The contemporary management of renal and ureteric calculi. BJU Int 2006; 98(6):1283-8.4. Logarakis NF, Jewett MAS, Luymes J, D’A Honey RJ. Variation in shock wave lithotripsy. J Urol 2000;163(3): 721-5.5. Loughlin KR. Management of urologic problems during pregnancy. Urology 1994; 44(2): 159-69.6. Ignatoff JM, Nelson JB. Use of extracorporeal shock wave lithotripsy in a solitary kidney with renal arteryaneurysm. J Urol 1993; 149(2): 359-60.7. Di Silverio F, Gallucci M, Alpi G. Staghorn calculi of the kidney: classification and therapy. Br J Urol 1990;65(5): 449-52.8. Lam HS, Lingeman JE, Barron M, Newman DM, Mosbaugh PG, Steele RE, Knapp PM, Scott JW, NyhuisA, Woods Jr. Staghorn calculi: analysis of treatment results between initial percutaneous nephrostolithotomyand extracorporeal shock wave lithotripsy monotherapy with reference to surface area. J Urol1992; 147(5): 1219-25.9. Lingeman JE, Newmann D, Mertz JH, Mosbaugh PG, Steele RE, Kahnoski RJ, Coury TA, Woods Jr.Extracorporeal shock wave lithotripsy: the Methodist Hospital of Indiana experience. J Urol 1986;135(6): 1134-7.10. Politis G, Griffith DP. ESWL: stone free efficacy based upon stone size and location. World J Urol 1987;5: 225-8.11. Lingeman JE, Coury TA, Newman DM, Kahnoski RJ, Mertz JH, Mosbaugh PG, Steele RE, Woods Jr.Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shockwave lithotripsy. J Urol 1987; 138(3): 485-90.12. Mays N, Challah S, Patel S, Palfrey E, Creeser R, Vadera P, Burney P. Clinical comparison of extracorporealshock wave lithotripsy and percutaneous nephrolithotomy in treating renal calculi. BMJ 1988;297(6643): 253-8.13. Graff J, Diederichs W, Schulze H. Long term follow-up in 1,003 extracorporeal shock wave lithotripsypatients. J Urol 1988; 140(3): 479-83.14. Hochey NM, Lingeman JE, Hutchinson CL. Relative efficacy of extracorporeal shock wave lithotripsy andpercutaneous nephrolithotomy in the management of cystine calculi. J Endourol 1989; 3: 273-5.15. Lingeman JE. Relative roles of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy.In: Lingeman JE, Newman DM, eds. Shock Wave Lithotripsy 2: Urinary and Biliary Lithotripsy. Vol 1. NewYork: Plenum Press, 1989, pp. 303-308.16. Gallucci M, Alpi G, Cassanelli A et al. Six-year follow-up in patients treated with PCNL and ESWL for staghornstones. J Endourol 1993; 7(Suppl 1): S105.17. Tiselius HG, Ringdén I. Stone treatment index: a mathematical summary of the procedure for removal288