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Nadiren de olsa, diğer girişimler başarısız olduğunda, böbrek pelvisi ya da üreterde bulunan bir taşı çıkarmak için açık cerrahi girişim uygulanır. Üreterdeki taşı çıkarmak için oluşturulan cerrahi işlem üreterolitotomi; böbrek pelvisim
deki taşın çıkarılması e elolitotomi: böbrek kaliksindeki taşın çıkarılması nefrolitotomi olarak adlandırılır. Taşlar kırılamadığı ya da transüretral yol ile çıkarılamadığında, suprapubik insizyon yoluyla mesanedeki taşın çıkarılması işlemine ise sistolitotomi adı verilir. Bu işlemler, büyük ya da tıkanmaya neden olan taşlarda uygulanır (8kz. Şekil 8.6),
Çok sık olmasa da, taş oluşumundan 50rumlu olabilen yaygın böbrek hasarı, ağır böbrek infeksiyonu ya da böbrek parankimasında
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