In a retrospective study we analyzed patients undergoing open stone removal in the Department of Urology of the University of Tübingen. In 2.7% of all urinary calculi, open stone surgery was necessary. Open operation was performed on all patients with complete staghorn calculi as well as on patients with renal pelvic stones and simultaneous morphological obstruction. Partial staghorn calculi were operated on only after endoscopic treatment had failed. Small renal pelvic stones and ureteral stones were surgically removed only after extracorporeal shock wave lithotripsy (ESWL) and endoscopic surgery had been unsuccessful. The treatment of choice for ureteral calculi is ESWL. If ESWL is impossible, an endoscopic approach is advisable. Open operations of ureteral calculi only have to be performed if endoscopic therapy has failed or if there is a simultaneous morphological obstruction. Meta-analysis of publications from 1981 to 1995 confirmed our approach regarding indications for open stone removal. Comparison of the results reported in the literature is very difficult because of the missing, but generally accepted definition of stone free. In addition different examination techniques to determine the status 'stone free' make it difficult to compare the various studies.