Extracorporeal shock-wave lithotripsy (ESWL) is the preferred treatment modality for renal and upper ureteral calculi. It is usually reserved, however, for urinary tract calculi above the iliac crest of the bony pelvis. A calyx calculus in a pelvic kidney was successfully treated with ESWL by using a C-arm fluoroscope to simulate the exact direction of the shock waves. The patient was then positioned so that the shock waves entered below the sacrosciatic notch. This same technique of exact patient positioning may have application in the treatment of some lower ureteral calculi.
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