Residual fragments after shock wave lithotripsy (SWL) represent a common and still controversial problem. These fragments can be important risk factors for stone growth and recurrence, may lead to symptomatic events and need further urologic treatment. The term "Clinically Insignificant Residual Fragments" (CIRF) is therefore a misnomer and should be abandoned. Although the goal of urolithiasis treatment is stone-free status, that the presence or non-infected, non-obstructive, asymptomatic residual fragments after SWL should be managed metabolically in order to prevent stone growth and recurrence. Further urologic treatment is warranted if the clinical indications for stone removal are present.