Objectives. To compare the current role of open stone surgery at our institution to previously reported data. In 1989, the indications for open surgical treatment of urinary calculi at our institution were reviewed. In the intervening years, tremendous advances have been made in minimally invasive treatment of urinary calculi. Methods. A retrospective evaluation of all patients undergoing procedures for the purpose of stone removal or fragmentation at Wake Forest University Baptist Medical Center between January 1, 1998 and May 31, 2001 was conducted. This was compared with data reported from our institution describing similar procedures in the first 19 months after introduction of the Dornier HM3 lithotriptor. Results. Of 986 procedures performed for the purpose of stone removal or fragmentation between January 1, 1998 and May 31, 2001, 0.7% were open surgical procedures. Of these procedures, 85.8% were performed for anatomic indications. Patients referred from other institutions for evaluation after endoscopic treatment failure comprised the remaining 14.2% of this group. In the previously reported data, 893 procedures were performed for the treatment of urinary calculi, of which 4.1% were open operations. Of these patients, 48.6% underwent an open surgical procedure after unsuccessful endoscopic treatment of urinary calculi, and 48.7% of these patients underwent open surgery for anatomic indications. Conclusions. Open surgical stone removal remains a viable treatment option for select patients. Technologic advances and improved surgical skills have greatly reduced the number of patients requiring open surgery. This approach is mainly used for patients with complex calculous disease associated with anatomic abnormalities. Copyright © 2002 Elsevier Science Inc.