It is the aim of the present paper to emphasize the uniformity of ethical principles which are applied in the large variety of methods for technology assessment, ranging from the level of the individual citizen to that of society as a whole. A further aim is to emphasize that the application of such ethical principles is necessary not only for assessment situations comprised within the classical doctor-patient relationship, but also for assessing mass applications of preventive interventions (a type of application which is not to be confused with the widespread post-assessment application of already-tested methods).

Percutaneous lithotripsy has achieved widespread diffusion throughout the medical community and is described by many authors as the manipulative treatment of choice in an increasing number of patients with renal stones. Appropriate use of percutaneous lithotripsy is not an isolated event of patient management but is considered to be one episode in the medical#surgical management of nephrolithiasis. Medical management must be initiated at the first determination of the presence of the stone or at the time of the diagnosis of one of the underlying conditions which predispose to stone formation. In spite of the fact that no randomized prospective trial studies are available, the overall preponderance of the available information is that percutaneous lithotripsy for the treatment of kidney stones is a safe and efficacious procedure. In addition, it has achieved widespread acceptance and is generally employed throughout the country. Cooperation between the physician responsible for medical management of the patient, the urologist, and the radiologist appears to be an essential ingredient for successful management. Long-term studies are indicated to determine the true incidence of complications and the long-range effects of the procedures employed by the percutaneous route.

The available information on transurethral ureteroscopic ultrasound and electrohydraulic wave lithotripsy in the surgical treatment of upper renal tract stones is presented above. It is significant that most reports add only 2–5 case studies to the literature and no large series of cases are reported. This approach to the surgical care of renal stones will have to be considered over the next several years against a backdrop of the current rapid spread in the use of percutaneous lithotripsy and the potential rapid diffusion of ESWL in the United States.