The surgical management of urinary calculus disease has changed dramatically in the past two decades. Minimally invasive options have made open stone surgery nearly obsolete. The development of shock wave lithotripsy, percutaneous nephrostolithotomy techniques and intracorporeal lithotripsy devices has conferred unprecedented management tools for upper tract stones. Moreover, transfusion rates, hospital costs, and convalescence periods have been markedly reduced when compared to open surgery. Likewise, the advent of fiberoptic technology has resulted in miniaturization of ureteroscopes making access to the entire collecting system possible from either a retrograde or antegrade approach. With experience, successful stone retrieval has occurred in upwards of 90% of cases, again with minimal complications. The subspecialty of Endourology has emerged over the past 20 years and significantly changed the management of urinary tract calculi within this short period of time. Further advancements in shock wave and laser technology, training modules and the development of more durable endoscopes may prove beneficial in providing even better stone treatments with a reduction in morbidity.