Stents must be judiciously, not indiscriminately, used prior to lithotripsy to maximize successes. The documented advantages for specific stone burdens and patient types should not be taken as an endorsement for pretreatment stenting on a routine basis. Universal stenting is a costly adjunct to an already costly technology, not to mention the substantial number of patients with stents who report bladder or renal discomfort that is relieved when the stents are removed. Certainly, in some cases, the constant discomfort of bladder irritability and reflex voiding secondary to polymer stents may be more incapacitating than mild colic associated with fragment passage. Complications of internal ureteral stents do occur, so judicious selection of patients for pre-ESWL stenting is advised.