We reviewed 50 patients with staghorn stones to determine whether extracorporeal shock wave lithotripsy monotherapy is a successful alternative to the classical approaches (open operation versus percutaneous lithotripsy alone or with extracorporeal shock wave lithotripsy). Results free of stones at long-term followup (greater than 3 months) were obtained in 28 of 50 patients (56%) and when we included residual fragments with a diameter of less than 4 mm. (9 patients, or 18%) an over-all success rate of 74% (37 patients) was achieved. Of the patients 41 had a Double-J stent to improve fragment evacuation (5 experienced obstructive elimination), while uncomplicated evacuation was noted in the remaining 9 without a stent. No case of septicemia after extracorporeal shock wave lithotripsy was observed but all patients had received strict antimicrobial prophylaxis.